LITMIR.BIZ

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position, five white-coated men and one woman formed a semi-circle around them.

      The doctor expanded a moveable screen across the opening to the cubicle and waved Alice out of his way with an impatient nod. She edged around the examination table and stood to Hetty’s right. Without preamble the doctor asked: ‘What are your symptoms, Madam?’

      Hetty glanced at Alice, who gave her a reassuring smile. She turned back to the doctor. ‘I-I’ve … it’s my chest, doctor. I have a sore chest.’

      Dr Harland pressed his fingers to Hetty’s wrist. He kept them there and stared into the middle distance. After half a minute he asked: ‘How long for?’

      ‘A few months now, though it’s been a bit worse lately.’

      The doctor shone a light in Hetty’s eyes. ‘When you say soreness, do you mean chest pains? Light-headedness?’

      ‘Not exactly,’ Hetty said evasively, looking back at Alice. The almoner reached for her hand and gave it a quick squeeze. Dr Harland pulled the stethoscope from around his neck and fitted the ear-tips in his ears. Wordlessly, he sought permission to listen to Hetty’s chest by raising the silver chest-piece and glancing at her from beneath his brow. She nodded hesitantly, biting down on her lip and closing her eyes as he parted the cardigan she was wearing and slipped the scope under her top.

      A sour smell wafted into the air. Almost immediately, the doctor’s expression changed. Slowly, he withdrew the scope and looked at her. ‘Please undress,’ he said, his tone marginally softer than before. Alice’s puzzled gaze flitted from the woman to the doctor and back again. The doctor turned to a silver trolley, handed Hetty a blanket and then motioned for the students to leave. ‘We’ll return in a moment.’

      When he came back, Hetty was sitting bare shouldered with her feet dangling over the side of the couch, a grey blanket clamped to her chest. ‘Come on, Hetty,’ Alice said, her cheeks drained of colour. She rested her hands gently on the woman’s shoulders. ‘It will be alright,’ she said as the woman shuffled back and leaned against some pillows, the blanket pulled up to her neck.

      Alice gave the doctor a grim nod. Gently, he eased the blanket down to Hetty’s waist, exposing one pale, sagging breast, the other shrivelled up and pitted with fungating wounds that oozed bright yellow fat and a pus-like fluid. The distinctive smell of rotting flesh immediately invaded the air. One of the male medical students gasped and took a stumbling step backwards. Another lifted his hand to cover his nose and mouth. A small whimper escaped Hetty’s lips. ‘It’s alright, Hetty,’ Alice said, stroking the older woman’s arm. ‘You are being very brave.’

      Another medical student decided he had seen enough and averted his gaze, but Dr Harland made a contemplative noise in his throat and leaned closer to examine the wounds. ‘Gentlemen,’ he said as he straightened. ‘And ladies,’ he added as an afterthought, his gaze sweeping over the assembled group. ‘This is actually very rare to witness,’ he said in a tone that revealed an interested fascination. ‘A tumour of the breast has clearly broken out onto the skin.’ He turned and leaned over again to get a closer look. ‘You’ll notice how the nodules have coalesced to form a mass of rotting tissue, some of it already turning necrotic.’

      Several of the students shifted from foot to foot. ‘Doctor,’ Alice snapped, glaring at him. Peter Harland looked up. She tilted her head meaningfully towards Hetty.

      He cleared his throat, straightened and pulled Hetty’s blanket back in place. ‘Madam, your condition is not one I’m able to deal with here on the chest ward. I’ll ask one of the nurses to dress the wound and then you will be referred to one of my colleagues.’

      ‘Thank you very much, doctor,’ Hetty said reverentially, but when he left, the students filing out obediently after him, her careworn features crumpled further. ‘I thought he was a chest doctor? I don’t want to go showing this monstrosity to someone else as well.’

      ‘It’s not his field, I’m afraid, Hetty,’ Alice said gently. ‘You need to see a specialist.’

      The woman chewed her bottom lip. ‘It’s bad, isn’t it?’

      Alice patted her hand. There was a pause, and then she said: ‘It has reached a difficult stage, but there are things that can be done to ease your discomfort.’ She levelled her gaze. ‘What prevented you from seeking help before now? You must have been suffering for quite some time.’

      Hetty’s rheumy eyes filled with tears. ‘I tried to push it out of my mind, I think, duck. I thought if I kept applying the poultices, it would sort itself out. Truth be told, I was too ashamed to tell anyone.’ There was another pause. ‘What can be done, do you think?’

      Alice looked at her. ‘The breast will have to be removed, and then some radium therapy perhaps. We will have to see.’

      The almoner sat with Hetty while one of the nurses applied liniment and dressings to the wound, then supported her as she made her way back to Ted, who was still waiting in outpatients. Since Hetty sat down without a word and took up her knitting, the task of explaining to Ted that his wife would need extensive surgery fell to Alice.

      Alice regularly found herself called upon to speak to patients by doctors who recognised that their bedside manner wasn’t quite what it might be. Ill at ease with breaking bad news and dealing with the subsequent emotional fall-out, they often called for an almoner to be present in the relatives’ rooms, sometimes even scarpering before the deed was done.

      The almoner finally resumed her office duties at half past eleven. With a pile of paperwork weighing down her desk, it was another half an hour before she had managed to extract herself to make her first house call of the day.

      The skies over the capital that morning were a cloudy, gunmetal grey, the wind that had dominated throughout the early part of the month persisting as the almoner made her way to Dr Harland’s sister’s house on Fenchurch Street.

      The clock on the mantelpiece in the living room struck 1 p.m. as Elizabeth Harland ushered Alice inside. In stark contrast to the smart, immaculately turned-out woman they had called on at the beginning of the year, her long gown was covered in damp patches across the chest, her shoulder-length hair hanging in uncombed tendrils around her face.

      The room was warm, the fire in the hearth emitting a comforting amber glow. The logs piled up beside it were the most ordered objects in the space. Almost every other surface was covered with badly folded piles of linen and soiled clothing, where before they had been adorned with highly polished ornaments and neatly stacked china.

      ‘I hope you do not mind my descending on you unannounced,’ Alice said as she rested her bag and folded cape on one of the few uncluttered spaces left on the sideboard. ‘But I plan to visit Charlotte as soon as I am able and I would like to give her some news of the infant.’

      Before Elizabeth could respond, a small mewing sound from across the room drew her attention. Alice followed her to the sofa, where Charlotte’s baby lay tucked up in a wooden drawer padded with blankets. Tightly swaddled, she blinked up at the almoner and emitted another contented coo. ‘May I?’ Alice asked, inclining her head towards the makeshift cot.

      Elizabeth nodded. The almoner removed her gloves and lifted the small bundle into her arms. ‘I was about to give her a wash, but we can take tea first if you’d like?’ the doctor’s sister said, after gesturing for Alice to take a seat.

      ‘Oh, no, you go ahead,’ Alice said, sitting down next to the drawer. She smiled down at the baby and slipped her forefinger into her tiny palm. ‘Do not worry about tea for me.’

      Elizabeth bustled out of the room. She returned a few minutes later, carrying some linen and a jug of water. ‘Come on,’ she said briskly, taking Daisy from Alice. Immediately the baby vomited on her shoulder.

      Elizabeth’s arms shot out, her face reddened in alarm. The baby hovered at arm’s length, her legs dangling below the unravelling blanket. A moment later, the woman recovered. She dabbed at her dress with a cloth, mumbled something in a mildly chastising tone then sat on a stool by the

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