17th November, 1939
A.C., 59, swollen painful R great toe. Tophae evident. Acute podagra. Rx colchicinum bd and review.
"Your young man," the colonel said, settling himself back comfortably among the overstuffed sofa cushions. Hilary, putting her dressing scissors back into her bag, glanced over. The colonel’s sly grin confirmed her suspicion that the choice of adjective was deliberate.
"Called up yet? Army, wasn’t it?"
Hilary snapped the bag clasps shut. "The pills won't work if you don't take them," she said, nodding at the colonel’s neatly bandaged foot, where it rested on the ottoman. It was her second visit that week.
The mantel clock ticked in the silence.
"R.A.F," she said, finally, the colonel’s grin not having shifted at all. "Flight school in Scotland."
"Ah." The colonel’s grin became a little more sincere. "Good for him. Difficult for you, though. On your own."
Hilary had been at church when the vicar announced that there was no response to Chamberlain’s ultimatum, and Britain was now at war with Germany. She had excused herself with increasing abruptness from the clumps that gathered for discussion after the service – so many opinions with so little evidence – to find Julian in her sitting-room, pacing the small area like a stag at bay, and determined, apparently, to marry her instantly, as his squadron had been called up. She was flattered until she realised the degree to which his conviction was driven by his equally strong belief in his own imminent demise (a flaming wreck or an empty sea, ripples dying into nothingness), whereupon she shocked both of them by bursting into tears.
Julian flung himself at her feet, apologising, promising by turns to be careful and offering to release her from her engagement, and Hilary, appalled at her own loss of control, had buried it entirely in love-talk and reassurances. The drama became farce when, at her urging, Julian phoned one of his fellow squadron members to find out that the call-up was for ground crew only, and pilots were to report in in a fortnight later and await further instruction. After a month he had been assigned an initial training wing, in Oxford, and a month later the news came of the posting to Grangemouth.
Two weeks ago they had been married. In hindsight Hilary retained only the vaguest of impressions: the slate-grey sky overhead, the cold damp that sank into the small congregation despite the church's well-stoked stoves, the smell of the hellebores that were the limited decoration (Hilary had been unable to prevent herself from wondering if Mrs Fleming, absent from the ceremony itself, had deliberately chosen to leave behind flowers that signified "poison" or whether the message was nothing more meaningful than the lack of other November blooms), the polite if baffled congratulations of her parents. Julian had gripped her hand tightly throughout as if fearful she would escape at the last moment.
But he had been the one to leave. She carried his latest letter in her coat pocket, an endearing mix of "darlings" and the flight slang he took evident pleasure in explaining to her.
"Oh, it’s not that bad," Hilary said. "I have my work." As she had given notice the day after their banns were first announced, agreeing to work out the time it would take the hospital to find a replacement, she expected the comment to ring hollow inside her, met with nothing but her own hypocrisy. Instead, it fell with the solidity of at least a partial truth.
She was due at the village hall at twelve to screen the most recent batch of evacuees. That should put any possible regrets firmly to rest.
5th March 1940, Bristol Royal Infirmary. Lecture series. Dr Stephen Falla, "Sulphapyridine: a double-edged saviour."
The lecture room was barely half-full, and most of the attendees well over the upper limit of the draft age. Hilary slipped in through the side door, seated herself with a minimum of fuss and dug out her notebook.
She had missed the preamble, but what interested her was the discussion. Last month she had been called out to a child in convulsions, feverish and with obvious signs of cerebral irritation; the spinal fluid drawn off at the hospital was thick with pus. Hilary had cautioned the parents to expect the worst but started the sulphapyridine, forcing it down the girl’s throat every four hours, and in two days the child was completely well. Well, that is, apart from the ulcers that coated her throat, signs that the drug that had saved her had also poisoned her bone marrow, leaving her prey to other infection. The week it took for the child’s blood counts to recover had been tense. Hilary had never treated a child that young with M&B before.
Falla was brisk and practical, his voice a warm Kentish burr. Hilary jotted down key points in a neat hand, asked about pentnucleotide, and sorted out in her own mind how she would approach the next such case. The talk concluded. She made a few additional notes while the topic was fresh in her mind and glanced up to see the next speaker take the podium.
The next speaker was David.
He apologised for the late substitution – an unavoidable and emergency operation – and began to speak with assured fluency on pneumonectomy techniques. Hilary realised she was staring and looked down quickly, but when she looked up again David caught her eye and, still speaking, lifted his eyebrows in acknowledgement.
She would have to stay. Both chilled and too hot, she wrote mechanically, blotting out any other memories the familiar voice stirred up.
The work settled her enough for a calmer and wiser internal counsel to be heard, one which pointed out how David carefully constructed his talk to be both self-deprecating and self-asserting; wild guesses that had worked out, mistakes that had, in the end, been the only right thing to do. She wondered, distantly, how his version of their relationship ended.
After the talk finished, and he, smiling, had answered a few questions (again demurring before putting forward his opinions), the room began to empty out for tea, and he came over to where she was seated.
"Dr Mansell," he said, smiling down at her. "What an unexpected pleasure."
"It is," Hilary said. "And it’s Fleming, now."
David’s eyebrows went up again. "Indeed. Congratulations. I believe that is the conventional thing to say?"
His tone implied that convention from Hilary was unexpected.
"Thank you," she said.
"And still studying." David waved one elegant long-fingered hand towards her notebook. "You always were the most conscientious of us all."
"Oh, I doubt that."
"Domesticity is an old but inescapable force," said David. He went on to describe his own marriage – to one of the theatre nurses, just after he’d been awarded his fellowship – and the arrival of his first-born son, seven months old and already a prodigy, although obviously his father was biased. He extracted corresponding details from Hilary ("No children? The air force, difficult, but at least you have his family? Oh. And you’re still in practice?") with the exactitude of a man eating whelks with a pin, and as little compunction for any harm suffered by the subjects. Hilary watched his mouth move and felt only disconnection.
Julian was brilliant but brittle. The last leave they’d had together, a 48-hour pass in a shabby boarding house in Leeds, had been equally exhilarating and despairing. He was determined to talk, to pour out his experiences in an unstoppable flood of names and planes and death, but it was when he came to the end of his words that Hilary was truly alarmed.
He could shatter. He wouldn’t warp, or deceive knowingly. All his lies were unconscious and driven by the urge to protect, not conceal.
"All doctors are needed now," Hilary said. "Even the conscientious ones."
She would review her notes on his talk later and see if there was anything there of relevance. Enough men had been called to action for a half-trained general surgeon, even a female one, to have her hesitant enquiries gratefully received by short-staffed hospitals, and her late arrival for today’s lecture – indeed, her attendance at the lecture at all – had been due to an interview in the same hospital.
11th October 1940. Rounds in morning, admin afternoon. On call.
"Light, sister," Hilary said, for the fourth time since she’d opened the abdomen. "Follow my hands."
The sister mumbled a sleepy apology. The light jerked back to where Hilary was tracing along the mesentery of the sigmoid colon, warm and damp against her gloved hand.
"Is it all right?"
Her assistant was a freckle-faced, enthusiastic and ridiculously young house surgeon, currently pulling back on his retractor and all too obviously vibrating with the urge to look down at the exposed bowel and check for himself. He had good instincts but bad luck, and Hilary had some sympathy for him despite the fact that he was responsible for her call-out at one o’clock in the morning.
("Dr Fleming? It’s Jason - Dr Nayman I mean. I’m terribly sorry. I’ve got this chap, a thirty-nine-year-old labourer with sigmoid volvulus, and I think I’ve stuffed it up. I really am sorry, but could you please come in? I’ve tried everything short of standing him on his head and shaking him.")
The sigmoid colon normally hung free in the abdomen, but if it twisted too far – and didn’t twist back – it could block and swell, and eventually develop gangrene. In most cases, it could be fixed without surgery, but in this case the boy – Nayman – had been right. The patient was quiet and pale, but flinched when Hilary pulled back the sheets to examine him, and his abdomen was board-rigid.
"No sign of perforation," Hilary said finally. Nayman heaved a sigh of relief, visibly deflating. "I don’t much like the look of this gut, but let’s get it untwisted first. It may be enough."
The operation was a sharp contrast to her earlier evening. Her nephew Sam had been in town (Hilary hadn't asked why, familiar with his tight-lipped responses to any work queries) and had insisted not just on dinner but dancing, despite Hilary’s protests of being an elderly married woman.
She hadn’t danced in years. Being held close, then spun away only to be caught back in again to the quick beat of the music, finding herself flushed and laughing in Sam’s arms, his body solid against hers; it made her miss Julian for his physical presence, with a deep ache she found harder to deny than the more familiar longing for his conversation. An air raid siren interrupted, forcing them all to troop downstairs to the cellar and stand there waiting for the all clear, packed in tightly enough that it was a relief when the signal sounded and they could escape into cooler air. Sam offered her a cigarette, taking one himself, and they stood at the side of the hall for a moment.
"Sky’s clearing up," Sam said, shaking out his match and nodding at the thinning cloud overhead. "More raids tonight."
"Pessimist," Hilary said, chastising.
"I could bet you," Sam said. He blew out a cloud of smoke and eyed her thoughtfully. "What will you give me if I’m right?"
His tone was intimate and inviting. Hilary, who had seen this coming, considered briefly how right the clergy were about the dangers of dancing and laughed.
"You haven’t changed since you were a small boy trying to wheedle me into buying more tea-cakes," she said, and saw Sam draw back, acknowledging her refusal.
"Can’t blame me for trying," he said.
A couple descended the stairs, giggling and clutching at each other for balance. Once they’d gone, it was a few minutes before Sam spoke again.
"Have you heard anything more?"
Hilary shrugged. "Only the Red Cross," she said. "I’ve sent letters, of course."
The delay between hearing Julian’s plane had gone down over France and the news that he’d survived, only to be taken prisoner, had been agonizing, but now waiting was only a little worse than it had been when he’d been flying. At least that was what Hilary told herself. She had established a tentative line of communication with Julian's mother – by letter only – and found such platitudes inescapable when writing.
She hoped Julian had someone there for him, in the camp. Neither Sam nor any of her other handful of offers had been were right for her – Julian would see them as replacements, not additional supports – but she hoped he had the sense to realize that she would see his actions differently.
Sam stood on the butt of his cigarette, grinding it out.
"Better get you home," he said.
She’d been asleep less than an hour when Nayman rang.
Sam had been right about the weather. The warning siren had sounded again as she hurried up the main stairs of the hospital, and throughout the operation there were distant thumps, and the answering rattles of the anti-aircraft guns. She realised as she made the initial incision that she still smelt of Soir de Paris, an odd mix with ether and antiseptic.
Hilary patted the now untwisted and neatly replaced gut with a damp gauze, and looked over at Nayman.
"Would you like – " she was saying, when overhead came a screech like an express train; silence for a few drawn out seconds, and then the whole room lurched sideways and the lights went out.
Hilary could feel the patient's pulse against her hands, steady and unaltered. She had lunged forward across his open abdomen, protecting him. As she straightened up she could hear creaking in the walls.
"Is everyone all right?" she said. "Sister, can you get a torch?"
The anaesthetist swore loudly and specifically about the German bombers. There was a stifled giggle from Nayman.
"I have no argument with that," Hilary said, and felt the tension ease further. "Are any of you injured? Dr Nayman, are you still sterile?"
The anaesthetist, Henley,had a cut on his forehead, from diving for shelter. Nayman was unharmed; he'd dropped his retractor, but otherwise hadn't moved. The theatre sister had fallen badly, and when she clicked on the torch Hilary had sent her for, her wrist was already beginning to swell.
"Right," Hilary said. "Let's close. Henley, can you bring him round?"
Two loud knocks on the door, and an ARP warden pushed his way in, torch swinging.
"Everyone out," he said. "Building's not safe."
The walls creaked again, as if in emphasis. They were in a side-wing, unprotected by the main bulk of the hospital.
Hilary glared back at him. "This is a sterile environment," she said. "Five minutes, and we're done."
She was not taking an open abdomen outside to expose to whatever filth the bomb had stirred up.
"You don't have five minutes," the warden said.
Hiilary could feel the others watching her. In the theatre –hers, not Julian's – there was only one lead.
"Sister, go," she said. "Henley, if you – "
"I'll stay," Nayman said. His freckles stood out against his skin when the nurse swung her torch towards him.
"Good," Hilary said. "You close, and I'll take the anaesthetic."
She had done it enough times at the county hospital when needed. She stripped off her gloves as the others left, the warden giving her a resigned look, and shone the torch onto the operating field one-handed as she pinched the patient's arm to check for returning muscle tone.
"Peritoneum first," she said, when Dr Nayman seemed unable to start, and then talked him through the closing of the muscle layers, and the switching of suture material before closing the skin. By this time she'd removed the airway, and the patient was twitching and muttering nonsense.
"Hush, now," she said. He quietened.
Something gave way in the roof with a slithering crash, and when she blinked away the dust, she could see stars.
The laparotomy wound was almost closed. Hilary put the patient's head back down, pushing his hair back from where it had fallen into his eyes, and fetched the wheeled bed. She and Nayman wrestled him onto the bed and out of the room.
They had him halfway down the outside ramp when the whole building shuddered and gave way behind them.
A warden with a clipboard asked for their names and indicated a staging area by the road where other evacuated patients were being sorted.
That done, Nayman shook himself all over like a dog emerging from water.
"Phew," he said, and looked at Hilary. "I say. Thanks for that."
Hilary pushed her hands into her coat pockets, and shrugged. "It's my job."