Medical Examination

I pulled down the stiff, wrought-iron door handle and dragged open the heavy, gloss-black-painted front door to West Street surgery. The building itself was a two story Victorian town house that had been converted into a general practitioners’ practice in the 60s. The door was four inches thick and had a strong hinge that required a hefty tug and left one slightly unbalanced after wrenching it open. I had an awkward altercation with someone trying to come out of the building as I was going in – I let them past, they let me past, I hesitated a little longer than them so they pushed past and gave me a little appreciative nod. A pointless gesture that wasted ten seconds of both of our lives.

Beyond the door, the reception desk was immediately off to the left and the waiting room was to the right up a flight of three stairs. Between these two destinations, in the opposite wall, was a door marked ‘private’, which presumably led around the corner to reception, next to which set into the wall was a small black plastic box similar to a letterbox, marked ‘repeat prescriptions’. I took a left.

The reception was a rectangular hole in the wall, three foot high by five foot wide, at hip height, so that I had to stoop slightly to look in. The bottom edge formed a desk with a computer, behind which was sat a lady in her fifties.

“Hi, I’ve got an appointment at four thirty”

The lady tapped at the computer keyboard for a few seconds.

“Name?” she requested, flatly.

“Jackson, um, John”

To the left of the desk was a corridor, running parallel to the front door, with two practice rooms, one of which I knew from past experience was where they administered holiday vaccines for tropical diseases. I flicked my eyes down the corridor to avoid the impression that I was staring at the reception lady, then looked back when she addressed me again.

“Yes, Doctor Fleischer’s a little behind today, take a seat.”

“Thank you.”

I turned as smoothly as I could and walked up the three steps into the waiting room. Five of the seats were occupied: a young, grizzly couple hissing back and forth at each other under their breaths; an elderly man who looked to be in impeccable health with a walking stick; a mother and her young child, who had rashes on his wrists. The waiting room had chairs lining the two opposite walls and half of the wall that had the door to the bathroom. I found a chair as removed as possible from everyone else to sit down – two chairs to the right of the mother, almost opposite the elderly man, with the couple in the farthest corner from me. This gave me a good view of the three steps leading back down to reception, from whence I had just come, and the three more steps leading further up into the rest of the building, where the majority of the practice rooms were.

Doctor Fleischer ended up being about forty minutes late, meaning I had to sit a while. During that time the couple were escorted down the stairs to one of the practice rooms by reception and the elderly man was called up the stairs. A couple more people came in to sit in the waiting room – a fat man who was entirely bald and sat down with a huff, and another elderly man – but I paid them little attention as I was sat waiting.

I also developed a headache that lasted about ten minutes and went away again.

“Mister Jackson?” a voice called from up the stairs, before a male head peeked around the corner to scan the waiting room for me.

I put up my hand and got up to follow him. Dr Fleischer waited for me to cross half of the waiting room before heading off to his practice room.

Up the three stairs was a long corridor. Immediately on the left wall was a door to a practice room, then a staircase up to the practice rooms of the dietician and the childhood booster vaccines, then practice room before the fire escape at the end of the corridor. On the right wall were three doors, the last of which was open with Dr Fleischer’s head poking out, which he retracted when he could see I knew which door to go through. I trudged up the corridor and entered after him.

The practice was a spacious room with an eight-foot ceiling. Bookshelves were everywhere neatly stacked with the obsolete books of medicine – the BNF 2018, or the 2009 Red Cross handbook – the entire contents of which made up a miniscule fraction of the information accessible to the GP via his computer. On top of the bookshelves were anatomical models of various vital organs and beautifully illustrated anatomical posters covered the walls, as well as an eye test, a BMI chart, a height chart. All useless for a GP with a university education but more comforting than a bare room for a patient.

Behind the door was a bed for examinations, covered in a fresh white paper sheet. The wall opposite the door had a large bay window, under which was Dr Fleischer’s desk. The desk was long, extending halfway into the room. The computer was on the window end of the desk, and Dr Fleischer was sat behind the desk so that he was facing me as I came in. Opposite the desk were two empty chairs. The screen of the computer was angled away from the chairs.

“Take a seat,” Dr Fleischer said warmly as I entered.

I don’t know why, but I always took this invitation as some kind of test. There were two chairs and only one of me. Should I take the furthest chair and move it closer for fear of appearing unhealthily lazy or should I take the closest for fear of looking unhealthily stupid? I took the closest chair and sat down. The doctor looked at me for a few seconds without saying anything, then he licked his lips.

“Now, you’re here because of your headaches?” he asked.

“Yes,” I replied, squinting slightly at the start of the pain, as at that moment, as if sensing its remembrance, a dull throb reemerged at the base of my skull. I immediately regretted squinting for fear of seeming unhealthily dramatic.

Dr Fleischer was a pleasant-looking man. He was pleasant-looking in the way that doctors often are – no more attractive than any other man his age, but somehow radiantly beneficent to be sat behind a doctor’s desk. He wrinkled his nose and lightly traced his beard from jaw to chin before launching into the spiel of questioning which was something of a formality in this era of diagnostics.

“Are you eating healthily?”

“I think so.”

“Are there any other… symptoms?”

“No,” I said, as it’s often hard to tell.

“Are you losing sleep?”

“Sometimes because of the headaches.”

“Do you exercise regularly?”

“Well, I walk to work. It’s 40 minutes by the river.”

“I see, I suppose you get enough sunlight as well then,” Dr Fleischer frowned, “Does your family have a history of… neurological conditions?”

“Wouldn’t say so. My Tadci had dementia when I was little.”

“Tadci?”

“Granddad, but my Dad hasn’t had it.”

The questions continued for quite some time on the subject of genealogy, first my Dad’s side and then my Mother’s. Eventually, Dr Fleischer evidently realized there was no more to be said of the subject without undergoing an examination, so he asked for my ethical consent form.

I got the folded piece of paper, carefully torn from the 20-page NHS pamphlet that was compulsory reading for applicants, out of my coat pocket and gave it to Dr Fleischer. He unfolded it, his eyes jumped straight to the bottom. He wrinkled his nose and set it down on his desk. He laced his fingers and rested his arms on the table, so that his interlocking hands were on top of the ethical consent form. Then, he proceeded to study me for what felt like a long time, staring directly at me, searching for any hesitation. As decided by a team of theologians, medical experts and lawyers at a year-long inquiry at Oxford University, my signature alone meant I consented to the procedure, but that I had to be in the room as it happened. I concentrated on breathing confidently while a time passed in which nothing was said. Eventually, Dr Fleischer licked his lips and stood, breaking the eye contact, then walked over to the head of the bed and looked back at me, decision made.

I got up and walked over, aiming to stand two thirds of the way down the bed, so there was a bit of distance between the doctor and I.

“Would you like to come and pull a chair over here?” asked Dr Fleischer while I was midstride.

“I think I’d rather stand.”

“Bring a chair over here.”

Dragging the chair made an unfortunate ‘squee’ sound, but for some stupid reason I’d judged the distance over too short to warrant lifting it. Dr Fleischer swallowed loudly a microsecond after I’d stopped pulling the chair, a sudden sound which left in its wake an unfortunately profound empty silence. I sat down and wallowed in it, and in my own thoughts of morality and ethics.

“Can I have your hand there?”

I put out my left hand towards him. Dr Fleischer took the couple of steps back to his desk, swiped up an oblong of rough-looking paper like filter paper and a needle then stepped back to the head of the bed, facing me.

“I’m going to put this paper between your fingers, just hold it there, and, when I tell you to, dab your thumb on it.”

Dr Fleischer put the paper between my index and middle finger and I did as instructed, balancing it like gangsters balanced cigarettes between their fingers in old films. Dr Fleischer moved closer to me and lined up the stubby, fine needle with my thumb.

“Just a sharp scratch here.”

Truth be told I didn’t feel the needle go in or out. In a very quick motion the faintly bloodied needle was back in Dr Fleischer’s hand and being thrown in the yellow biohazard bin before I felt it go in. Only afterwards was there a sensation like a papercut, by which time a droplet of red was beginning to swell on the end of my thumb.

“Dab here, please.”

I dabbed my thumb on the paper and handed it to Dr Fleischer, who in return handed me some medical tissue paper. I wrapped this around my thumb and made a fist. My thumb throbbed warmly and uncomfortably in the fist but I didn’t want to make a bloody mess, not in front of a doctor, not from a little needle, so I held it in place.

Dr Fleischer produced from his lab coat a little vial of liquid. This liquid never ceased to fascinate me – it was flecked with gold particles that shone, and its body was such a rich, royal blue that one felt unworthy to look at it. Miraculous science flaunted itself before me and demanded I bow before it. I looked down at the floor and then back up as Dr Fleischer carefully dripped a drop of the blue liquid onto the paper dabbed with my blood, then another drop, then tapping out a third. He blew over the mix of blood and blue liquid then rested the paper in the middle of the bed, rotated it so that it lay straight, then stood back. He turned an egg timer and it began ticking down.

For a minute or two nothing appeared to happen, though as had been explained to me on a couple of previous occasions this is because cell division is a cumulative process, and cells have to divide very rapidly to begin with to form any change.

Sure enough, soon enough, a mass, red and fleshy in colour and aspect, broke the thin surface of the blue liquid, growing fast upward and outward, until it was about the size of one’s big toe. The mass wriggled as it grew, a seemingly conscious effort to keep itself orientated with the paper. The mass furrowed and invaginated at both ends, what I assumed would be the beginning and end of the digestive system. Formed in a process too slow to observe, a rough head-shape had developed at the top end. As arms and legs invisibly took form from the outer tissue of the fleshy mass one of the invaginations developed into a mouth, eyes surfaced as black dots which quickly complexified, a nose rose between the two, the curve of the scalp became defined, ears appeared, legs and arms diversified feet and hands, which in turn grew fingers and toes. In a matter of minutes a fully formed human baby was present. Dr Fleischer stepped forward and deftly cut the umbilical cord, which had been hanging limply to the left of the form, and disposed of it into the biohazard bin. The hair that began to sprout from the scalp, an Aryan blond, I knew would eventually darken to dark brown. The creature’s eyes were an intense azure and were roving around in their sockets, trying desperately to make sense of its surroundings. My eyes were on the creature the whole time, and I was intensely glad of my chair. No matter how many times I witnessed an examination, it never ceased to unnerve me.

The creature was still growing, his legs and arms stretching towards the end of the bed, muscle and fat barely developing fast enough to fill them out. Facial features contorted slightly with puberty’s hormones until the features very clearly matched my own. The creature’s eyes became panicked. I thought about empathy, but not empathy in myself. I wondered what empathy other people felt in this situation. Every examination, as I watched my life played out to me in front of me, I wondered whether anyone else wondered what that creature’s lot could be. I always wondered, and I wondered if other people wondered.

A bruise billowed and blossomed in the creature’s side and it flinched heavily to one side. I winced too at the memory of grazing a speeding vehicle when I was 17. The creatures face was a grimace, resembling that of an infant who’s fallen over for the first time.

Periodically, the creature would sniffle and sicken, its skin growing grey for a couple of seconds – every cold, every flu, every fever, lived out in micro for the past 38 years of my life. More bruises continued to surface and vanish.

Without warning there was a horrifying crunch as I dislocated and fractured my kneecap when I was 31. The creature cried out in agony and tears welled up in both eyes. The creature’s eyes stopped roving and it locked eyes with me, eyes bloodshot with the sudden pain, and it reached out its closest hand towards me. Dr Fleischer reached down and slapped the arm back down to the bed. It was a short, light slap – more of a non-verbal instruction than a reprimand – and Dr Fleischer did it with a dispassionate expression on his face. However, Dr Fleischer did hold the slapping hand for a good time after and I saw his knuckles go white. The creature obeyed.

It was then that I realised that I was still holding the fist with my thumb, and that my knuckles were also white, and that my thumb had lost all sensation.

Over the course of a couple of seconds pinprick dots flashed around and around his right hand, scores and scores of little needleholes which danced around his finger tips. The man yelled something unintelligible, but angry, hurt, sad, betrayed, lost, broken and lonely. The egg timer went off on the desk. The man didn’t notice as he was still shouting angrily at the ceiling, when Dr Fleischer administered a drug to the man’s neck by way of a hypodermic needle to the man’s neck. All of a sudden the shouting stopped, the moving of the chest and diaphragm became very slow and the pupils dilated, annihilating the grey irises in pearly blackness.

The man opened his mouth, and died.

He had dark brown hair and grey eyes and on his shin a bruise which matched tripping up the stairs yesterday.

Dr Fleischer and I stood and sat very silently for a moment.

The white sheet covering the examination bed was flecked with splashes of blood from my injuries. Dr Fleischer walked to me and passed me, standing next to the dead man in the bed. Self-consciously I shuffled back in my chair away from the doctor and the bed. Dr Fleischer cut strips in the sheet at the level of the dead man’s hips and wrapped them around him to cover his dignity as he lay naked and dead. With one hand on the dead man’s shoulder and the other on the bed, Dr Fleischer carefully turned the corpse over onto its back.

Dr Fleischer laid a set of scalpels on a metal coffee-table-like piece of furniture by the head of the bed.

“Now,” said Dr Fleischer “These headaches you’ve been having, where exactly are they?”

I knelt down next the doctor, who was bending over the dead man, and wordlessly pointed to the point between the back of my head and the start of my head where the pains seemed to be coming from. Dr Fleischer made one clean cut with the scalpel, then another, then another in the area where I had pointed to, then peeled back the flesh and tacked it back out of the way. Scalpels are terrifyingly sharp – though the lacerations seemed to have cut cleanly through, now the flesh was flayed it was obvious that he had cut to the bone of what had been a replica of my own neck. I’d always thought of myself as quite a durable person, a solid person, and that, as I’d lived in it my whole life, my body was a sturdy home. Yet here, dead and under the knife, I seemed such a fragile thing.

Dr Fleischer was searching somewhat frantically through the sinews which lay around the bone of my upper vertebrae. The area he had opened up was from a little bit above the base of the skull to a little below the fourth vertebral bone and Dr Fleischer, with careful incisions, removed the fourth vertebral bone, then the third, then the second, then the first, examining each one as he went for any peculiarities, and then turned back and froze for a second. He leaned in close to the base of the skull which was now visible. Dr Fleischer got out a slender torch with a thin beam and shone it at whatever was there.

“Come here.”

I moved closer and squinted into the excavated interior of a dead man’s spinal column. It was fairly obvious that there was no way this corpse could now sustain life – with its flesh flayed, its top four vertebrae missing and area excavated from its spinal column and the base of its skull. Peering into the incision, I felt intensely glad to not have been the one being cut up.

The sight seemed pretty uniform to me, or at least uniformly incomprehensible – slimy bits of flesh in different shaped structures which seemed hardly distinguishable from one each other, seamlessly merging together in the way visceral biological structures do.

“See here?” Dr Fleischer indicated with the torch beam a circular area of whitish-grey tissue at the base of the skull “This is nerve tissue. You see this area which is discoloured? This is also nerve tissue. I’m glad you came to me when you did, there is time. I’m referring you to oncology at Saint Mary’s.”

Dr Fleischer removed the tacks from the flayed skin so that it may flap closed, and neatly laid the removed vertebrae on the bed. He then pressed the button on his desk to call for a nurse to move the body, and from under the bed got out a freshly folded white paper sheet, which he laid on the desk while he waited for the nurse. He then walked back over to the bed and stood before it, staring down reverently at the dead man. He then turned to me and gripped me on the arm near the shoulder.

“You’re very lucky.”