Ken McClure: Past Lives

‘Mac, it’s Carl,’ said the voice of Carl Lessing, Chief of Neurological Histopathology. ‘I was just about to call you. I’ve been looking at the Francini sections. Sorry for taking so long but it’s bad news, I’m afraid. The tumour was malignant and pretty aggressive too. If you have a moment maybe you could come down? There’s something I’d like you to see.’

‘On my way,’ said Macandrew.

Macandrew took the elevator to the basement where the Pathology Department was situated. His eyes watched the floor indicator but his mind was on other things. Jane Francini’s pre-op scans had only shown up a single tumour but in view of what Lessing had just told him about the tumour’s aggressive nature, maybe there had been small secondaries that hadn’t shown up or worse still, had been so small that he’d missed them. This would be one explanation for her condition.

Lessing, a thickset middle aged man with a mane of white hair and a goatee beard sat at his microscope with his glasses pushed up on his forehead. The fingertips of his left hand adjusted the fine focus control of the instrument while he made notes on a spiral-bound pad with his right.

‘What have you got?’ asked Macandrew.

‘Take a look at these two tissue sections. Tell me if you see a difference.’

Macandrew took Lessing’s place and widened the binocular eyepieces a little before looking down. After a few minutes he said, ‘ Both are malignant.’ He sounded surprised. He had expected one to be normal.

‘No difference?’

‘Stain colour maybe.’

‘Exactly,’ said Lessing, pleased that Macandrew had picked up on it. ‘The one on the left is Jane Francini’s tumour but the haematoxylin staining is a different colour from the more normal reaction of the other one although, as you say, both are malignant. That’s what caught my attention. The colouring’s unusual and it rang a bell from way back: I think the Francini tumour is a Hartman’s tumour.’

‘A what?’

‘This is not a big gap in your knowledge,’ said Lessing. ‘It’s only the second I’ve come across in twenty years. It was named after the first patient to present with it, Mona Hartman. The tumour cells produce some kind of acidic chemical that affects the staining process in the lab. That’s what brought it to mind — that and the fact that some guys over in Europe did some research on it a couple of years ago and I remembered reading about it. How’s the patient doing anyway?’

‘Not good. I was confident I’d got it all out but the way she’s behaving says there’s something really wrong... maybe there were secondaries that didn’t show up on the scan — or I didn’t pick up on them...’

Lessing could see that Macandrew was worried. ‘Would it help if I was to have a look at the scans?’ he asked.

‘I’d be grateful.’

Lessing asked one of his technicians to fetch Jane Francini’s brain scans. Macandrew told her where to find them.

‘Coffee?’

They went next door to Lessing’s small and cluttered office and he poured coffee from a large flask sitting on a hot plate on top of a filing cabinet. Lessing lit a cigarette.

‘These things will kill you,’ said Macandrew in a weak attempt at humour when he didn’t feel in the least humorous.

‘Something’s going to for sure,’ replied Lessing, displaying the philosophy of a long-serving pathologist.

The technician returned with the scans and Lessing clipped them up on a light box. He examined them for a good five minutes — occasionally employing a small magnifying lens — while Macandrew sipped his coffee and watched.

‘Just the one, as far as I’m concerned,’ announced Lessing.

Macandrew let out his breath in a long slow sigh. ‘Thanks Carl. I didn’t think I’d missed anything but you never know...’

‘I’ll see what I can dig up on Hartman’s tumours,’ said Lessing. ‘I’ll give you a call.’

Macandrew went back upstairs and called Klinsman from his office. Diana French answered. ‘I’m sorry, Mac, Saul has gone for the day.’

Macandrew called Klinsman at home but there was no reply and he decided not to leave a message on the answering machine. He thought about contacting Tony Francini personally to tell him the bad news about the tumour but decided against it. There was still a slim chance that Jane might come out of it OK. He would wait until she surfaced from her sedated sleep before saying anything to anyone. He looked at his watch. With the schedule he had written her up for, Jane Francini would be out for another eight hours at least.

Macandrew didn’t feel like cooking when he got in. Instead, he fetched a packet meal from the freezer and put it in the microwave. When it emerged, it bore little or no resemblance to the appetising delight depicted on the pack. “Delicious Cod Steaks in a light wine sauce” had become amorphous yellow goo. He got a Bud Light from the fridge, picked up a fork and settled himself in front of the television to watch the news while he ate. His attention span only lasted as long as the goo. He picked up then channel changer and started hopping through the stations. Nothing could hold his interest. He couldn’t get Jane Francini out of his mind.

At first, he found his preoccupation hard to bear. After all, he wasn’t an intern wrestling with his first brush with failure. He was a seasoned surgeon who knew and understood the score. Dealing with life and death was part of the job. He was good at his job but he wasn’t a miracle worker. He didn’t pretend to be. So why couldn’t he come to terms with the Francini case? Maybe it was her husband who was bothering him? Listening to him hadn’t been pleasant but then people said all sorts of hurtful things when they were upset and Francini had certainly been that. His wife, as he had put it, was everything to him.

It wasn’t Francini’s behaviour, he concluded, it was Jane herself. He had come across patients who had lost their minds before but Jane Francini was different. Something her husband had said kept coming back to him. He said that she looked like Janey... but she wasn’t.

The more he thought about it, the more convinced Macandrew became that he was right. She just wasn’t Jane Francini any more...

Macandrew didn’t have an operation scheduled for the following day so he permitted himself a couple of large Bourbons. He needed a good night’s sleep and the alcohol would help. Normally he would sleep late when he wasn’t operating, take a leisurely shower and read the morning paper over breakfast but tomorrow he wanted to get into the Med Centre early. He wanted to be there when Jane Francini came round. Please God she would have recovered but somehow he feared that this was wishful thinking. He tried looking up Hartman’s Tumour in his textbooks but failed to find any mention. If Carl Lessing didn’t come up with something, he would take a trip to the Med Centre library.

Jane Francini regained consciousness shortly after six thirty am. For a few brief moments Macandrew thought that things were going to be fine; she appeared relaxed and sleepy and the sounds she made were soft and feminine as she moved her head on the pillow. But as he came closer to listen to what she was saying, he realised that all was not well. Jane was speaking in the little girl voice that she had lapsed into on one occasion yesterday.

‘Jane!’ whispered Macandrew in her ear. ‘Can you hear me?’

‘Why are you calling me Jane?’ replied Jane, without opening her eyes.

‘Because that’s your name,’ continued Macandrew gently.

‘Don’t be silly, it’s Emma.’

‘Emma who, Jane?’

‘Emma Forsyth. Stop calling me Jane! Where’s my mother? She said she would take me to town today.’