Goldblatt's Descent

Michael Honig

• Publisher: Atlantic Books
• Year: 2013
• Print ISBN: 9780857897039
• eBook ISBN: 9780857897022
• Topic: Letteratura
• Subtopic: Letteratura generale

Angry, satirical, hilarious and eventually heartbreaking, Goldblatt's Descent tells the story of a young, talented hospital doctor, an idealist in a very imperfect world. A biting, brilliant, black tragicomedy of doctors, patients, lost hopes and last chances. Malcolm Goldblatt has one last chance. Life, or his own obstinacy, has dumped him at the door of Professor Andrea Small's medical unit, where he will have the privilege of ministering to the world's most unimportant disease. But in so many ways, this unit is like all the others that Goldblatt has worked on, from Dr Madic's ferocious aversion to work, to Dr Burton's knife-in-the-back ambition, right up to the monstrous vanities of the professor herself - and that's before he even meets the patients. Soon the familiar cycle of hope and despair threatens to drag him into its eddy, and with his finger never far from the self-destruct button, the temptation to press it for what will surely be the final time begins to feel less like professional suicide and more like salvation.

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1

THE PHONE STILL HADN’T rung. Typical, thought Ludo.

It was a small white phone and it sat smugly, toad-like, on a desk strewn with laboratory forms, patients’ notes, test results, and large cream-coloured X-ray folders. Ludo stared at it resentfully.

According to the timetable she had been sent, a round was supposed to be starting in the doctors’ office on the ward on the seventh floor, but no one else was here. It was Ludo’s first day on Professor Small’s unit. She had already bleeped the specialist registrar three times. Bleeps were supposed to be answered. That was the theory, anyway.

Ludo was still staring at the phone when Goldblatt came in. She glanced up at him.

‘And you are...’ he asked.

‘The new senior house officer,’ said Ludo.

‘How convenient. I’m the registrar.’

‘Then maybe you can tell me what’s supposed to be happening.’

He shook his head. He couldn’t tell her what was supposed to be happening because it was his first day on the unit as well. He sat on the edge of a desk. ‘Malcolm Goldblatt.’

‘Ludo.’

Goldblatt frowned. Ludo? Wasn’t there a game called Ludo? He was sure there was. He wished he could remember how Ludo was played or what it was or anything at all about it. There were so many facts he had known at various times in his life and that he had forgotten. Yet it was never possible to be certain, before you forgot them, which ones you would later need and which you could safely consign to oblivion, and often you mistook one for the other. That was the irony of it. But it was only one of life’s ironies, he knew, and not the greatest.

He glanced at Ludo again. She was going red with some kind of embarrassment that he couldn’t fathom. Maybe she was named after the game. Maybe she was conceived after a game. Maybe she was conceived during a game...

‘Ludka,’ Ludo blurted out. ‘All right? It’s short for Ludka.’

‘Ludka?’

‘Ludka Madic.’ She pronounced it with a hard c at the end, and had gone redder, as if she had just revealed her most harrowing secret. But she hadn’t. That came next. ‘It’s Serbian.’

‘Then you should say Madich, shouldn’t you?’

‘Everyone gets it wrong,’ replied Ludo sourly, ‘so I just say Madic.’

‘You shouldn’t deny your heritage.’

‘Why not?’ demanded Ludo with what seemed very much like heartfelt bitterness. ‘Everyone hates the Serbs.’

That was a sweeping statement, thought Goldblatt. On the other hand, a statement wasn’t wrong just because it swept. This was only a few years after the war in Bosnia had been brought to an end following half a decade of determined condemnation by the nations of western Europe and an equally strong determination by the troops of those nations to get out of the way whenever civilians were being massacred. There was probably more truth than lie in Ludo’s remark.

‘I don’t hate the Serbs,’ said Goldblatt. ‘For the record.’

Ludo turned away and looked back at the phone. Goldblatt watched her. She had porcelain blue eyes and the lids hung low over her irises, giving her a kind of doped appearance. She had thick white skin, with a couple of spots of acne on her cheeks. Her long dark hair hung loose down her back. She was wearing a white doctor’s coat, and she sat with her arms folded across her chest. A purple woollen skirt stretched over her thighs.

‘Have you bleeped anyone?’

Ludo rolled her eyes, not bothering to reply.

‘I’m going to take that as a yes.’

Ludo had finished her previous job in Leicester the day before, and had woken up at four o’clock to be in London in time to start her new job on Professor Small’s unit. The hospital had said they would give her a room for up to a month while she found a place of her own, but when the taxi dropped her at the accommodation block she couldn’t get in. She had had to stand in the cold until someone happened to come out and she could sneak inside. Then she found a note with a number to call for out-of-hours’ assistance pinned to a board behind a little desk, and it took half an hour for someone to turn up once she had rung it. The only assistance he could give was to tell her that her room wasn’t ready and he didn’t know where she could leave her bags, so she had to leave them behind the desk, where he grudgingly allowed her to deposit them, and hope no one would steal them. Then she had come up to the ward, and the specialist registrar wouldn’t answer her bleep and there was no sign of anyone, not even a house officer, and all she needed now – all she needed now – was for some registrar to turn up and tell her not to deny her heritage as if she was a Serbian nationalist or Radovan Karadži[ć]’s daughter or cousin or had even met him or something.

Actually, she had met Radovan Karadži[ć], but that was when she was eleven and her parents had forced her to rehearse for a folk dance with some other girls at the Serbian cultural centre in London, and they all performed in front of him and a bunch of other lecherous-looking guys who had come on a visit from what was then Yugoslavia. Her parents were big on Serbian culture. One of the men had squeezed her bum as they lined up in front of them after the dance, although she couldn’t remember if that was Radovan Karadži[ć] or one of the others. At that stage Radovan Karadži[ć] was just another one of those lecherous guys, no one special, some kind of a poet or something, and it wasn’t until years later when everyone was saying he was a war criminal that her mother reminded Ludo that she had danced in front of him. It was true, her father said, she should be proud of it. She wasn’t proud of it. It made her sick. But she was eleven at the time and it wasn’t her idea, anyway. And who could have known what the tall man with all that silver hair was going to turn into and that she would have to live the rest of her life with the terrible secret that she had danced for a war criminal and had possibly even had her bum squeezed by him?

‘It’s so unfair,’ muttered Ludo.

‘What?’ asked Goldblatt.

Ludo didn’t reply. Goldblatt guessed there were many answers to that question, and he was fairly certain he didn’t want to hear any of them. He pondered his options. On the one hand, he could launch into a discussion of the atrocities and assorted illegalities of the Balkan war with his new senior house officer, who appeared to be an aggrieved Serb nationalist with a chip the size of Bosnia balanced precariously on her shoulder. Or on the other hand...

‘Did you say you bleeped the SR?’

Ludo nodded.

‘What’s the number?’

Ludo pulled a piece of paper out of the pocket of her white coat. ‘403.’

‘How do you bleep here?’ asked Goldblatt.

‘Dial eleven, then the bleep you want, then your extension,’ she replied, reading mechanically from the paper.

Goldblatt picked up the phone. Ludo watched him as he dialled the numbers and then put it down again.

‘There’s meant to be a round,’ said Ludo.

‘When?’

‘Now. That’s what it says on the timetable. Don’t you have a timetable?’

Goldblatt didn’t have a timetable. They might have sent him one.

Ludo examined the piece of paper. ‘Wednesday, nine o’clock, round.’

‘Here?’

‘That’s what it says. Starting in the doctors’ office on the ward.’

‘Well, that’s definitely here,’ observed Goldblatt.

Ludo glanced at him impatiently, then stared at the phone again. ‘It really pisses me off when people won’t answer their bleeps.’

Goldblatt looked around the doctors’ office, hoping that if he didn’t respond the whining tone that had crept into Ludo’s voice would recede. A pair of desks stood on either side of the room with a shelf bracketed to the wall above each one, accompanied by an unmatched assortment of office chairs and a metal trolley on wheels with hanging files containing the medical notes of the patients on the ward. An X-ray box and a whiteboard were fixed on the wall opposite the door. To all intents and purposes a standard issue doctors’ office, not excepting the horrendous mess of notes and papers scattered across every available surface as if left behind by the retreat of some kind of medical tsunami.

‘It really pisses me off when people won’t answer their bleeps,’ Ludo repeated, apparently mistaking his silence for encouragement. The whining tone had got worse, and it was downhill from there. Ludo went back to the sound of her alarm clock waking her at four that morning – even though strictly speaking she was supposed to be whining about people not answering their bleeps – moved methodically on past the businessman who supposedly ogled her in the train all the way down from Leicester, the taxi driver with the hacking cough who had probably infected her with something on the drive to the hospital, the wait in the cold outside the accommodation block which would almost certainly have exacerbated whatever she had caught in the taxi, and the strong likelihood that, even as she whined, her bags were being stolen. She whined at a regular, measured pace with the air of a professional, and obviously had the stamina to go on for hours.

Goldblatt had a dismal premonition that this wasn’t going to be the last time he heard that tone in Ludo’s voice.

‘Tell me about the first patient,’ he said, desperate for it to stop. He threw a glance at the notes trolley. ‘Simmons,’ he said, reading the name on the first folder. ‘Tell me about Simmons.’

Ludo stopped in mid-whine and stared at him in disbelief. ‘How should I know about Simmons?’

‘I’m your registrar. You’re my senior house officer.’ Goldblatt looked at his watch. ‘It’s ten past nine. How long have you been here? You haven’t done a thing.’

‘I’ve been talking to you!’

‘Exactly. I expect you to know your patients before you sit around talking to me, Dr Madic. I expect you to know them inside out. You’ll know their haematology, their biochemistry, their serology, and their hepatology. You’ll know what tests have been done, what tests have been ordered, and when the results are going to be back. Is that clear, Dr Madic?’

Ludo’s mouth had fallen open. Goldblatt wondered how much more of this rubbish she was going to fall for. He thought he might as well find out.

‘I don’t expect Professor Small to hang around while we familiarize ourselves with her patients. Do you? The Professor deserves a little more respect, Dr Madic, and you’d better start showing it.’ He shook his head in admonition. ‘Simmons,’ he announced, as if he had come in earlier to check the notes and actually knew something about the patient, ‘a seventy-two-year-old woman with a past history of Wernicke’s encephalopathy and cerebellar dysfunction secondary to—’ Goldblatt stopped, scrutinizing Ludo’s paralysed face. ‘Give me the causes of cerebellar dysfunction.’

Ludo looked around helplessly.

‘Come on.’

‘Multiple sclerosis?’ she whispered.

‘In a thirty-five-year-old, maybe. In a seventy-two-year-old? I think we can start with something a little more common, don’t you?’

‘Stroke?’

‘Yep!’ said Goldblatt, sticking out his thumb. ‘What else?’

‘Ah...’

‘Come on,’ said Goldblatt. ‘Stroke.’

‘Didn’t I say that?’

‘Alcohol,’ said Goldblatt, snapping out his index finger. ‘Tumour, hypothyroidism, heavy metal poisoning.’

All of Goldblatt’s fingers were extended. Ludo was watching him, eyes narrowed in hostility.

‘And?’ said Goldblatt. He closed his fingers and extended his thumb again. ‘And?’

Ludo sneered. ‘And what?’

‘Lithium toxicity. How many times did you fail your first part?’

‘Five.’

Goldblatt stared at her. He was impressed. Or perhaps that wasn’t quite the right word for it. The first part of the exam for membership of the Royal College of Physicians, which was taken two to three years after qualifying in medicine and starting work as a doctor, was the gateway to the multi-year-long obstacle course known as specialist training. The second part exam came a couple of years later. If you failed the first part six times, you were barred from trying again – your career as a specialist was over before it had begun. It was a tough exam, and it was no shame to fail once or even a couple of times. But failing five times and turning up for a make-or-break last attempt... Goldblatt had never met someone who had actually done that, although he had heard that such people existed. The way you hear of people who take twelve hours to finish a marathon but keep going to the end and then you wonder, honestly, why they bothered.

‘That’s quite something,’ he said eventually.

‘Thank you,’ said Ludo tonelessly.

‘That really is... special.’

Ludo rolled her eyes.

‘Simmons,’ said Goldblatt. ‘Seventy-two-year-old woman with a history of cerebellar dysfunction secondary to lithium toxicity, who was admitted four days ago for a suspected myocardial infarction complicated by inframammary candidiasis.’

Ludo looked at Goldblatt suspiciously. ‘What do you mean, complicated by inframammary candidiasis?’

‘Thrush under her boobs, that’s what I mean. Don’t you talk medical?’

‘I know what you mean. You just said she’s had a heart attack. Who cares if she’s got thrush under her boobs?’

Goldblatt gazed at her sternly. ‘She cares. So I care. And that means you care, Dr Madic! Have you ever had thrush under your boobs?’

Ludo grimaced.

‘All right, ...

Table of contents

• Cover
• Title page
• Copyright page
• Contents