Letters from Alice: Part 2 of 3: A tale of hardship and hope. A search for the truth.

Alice glared at the doctor. ‘My patients?’

‘Yes! The troublesome ones that you insist on sending up here!’

Alice’s nostrils flared. ‘What do you expect me to do with them, then?’

‘I thought your job was to ensure the smooth running of the hospital,’ the doctor snapped. ‘You seem to create a commotion wherever you go.’

The flush rising from Alice’s neck and up to her cheeks evidenced her fury. ‘First and foremost my duty is to ensure that patients have the best possible chance of making a full recovery, doctor. It is not, as you seem to believe, to make your life more convenient. And if you think –’

Dr Harland held up a flattened hand in front of her. ‘Please stop speaking,’ he said. ‘If you have an urgent case, bring them up in one hour.’ He turned on his heel and dived into his office, slamming the door loudly behind him. The almoner stared at the door with a look of disbelief. After a moment she returned to Nell at the main reception and shook her head silently. The nurse returned her exasperated look. ‘Our lord and master’s finally graced us with his presence then, I see.’

Alice nodded then looked at her thoughtfully. ‘You mentioned that the doctor often goes AWOL,’ she said slowly, leaning close to the counter. ‘Do you have any idea where he goes?’

‘You might well ask,’ the nurse said, and then she gave the almoner a meaningful look. ‘Perhaps Mr Jimmy Rose isn’t the only one with secret lady friends around here. Although why the doctor would feel the need to leave the hospital to find one I have no inkling. Lord knows there are enough simpering, silly nurses up here throwing themselves at him.’

Alice pursed her lips, then nodded to the nurse and reached for her hat.

‘Come back for a cuppa when you’ve got more time,’ Nell said, as Alice walked away. ‘And make sure you bring news of that convalescence home along with you. Something’s got to give sooner or later.’ She leaned over her desk as Alice pushed on the doors leading to the stairs. ‘I’m not a miracle worker, you know.’

Chapter Ten (#u7a1e77c4-e54c-5bcf-adf1-4b859ee7628e)

It is the stoutest, not the kindest, heart that is wanted … all we have to do is weather the storm as well as we are able, taking additional care to be vigilant and strict in keeping all members of the community within the bounds of duty.

(Quoted by Mr Longley in his Report to the Local Government Board on Poor Law Administration in London, 1874)

As each year passed, Alice and her colleagues’ ‘people’ skills were to be increasingly drawn upon by the medical staff, the frontiers of their work creeping ever more forward. It wasn’t until the Second World War that their contribution would be fully appreciated, however, and then officially recognised.

During the nightly bombing raids over London, the almoners were the ones who cushioned the trauma for patients bunkering down in shelters specifically built by the Ministry of Health. They helped to fill the sandbags that were to be piled up around the entrances to the hospital and taped up its many windows with blackout curtains. They were the ones providing the sick with hot tea from thermos flasks, extra blankets and words of reassurance, and reuniting lost children with frantic parents. And then, in the aftermath of the raids, they shouldered the task of salvaging what they could from the ruins of bombed-out homes, liaising with the authorities and charitable bodies to help rebuild devastated lives.

Rotas were reorganised through the war years to ensure that the almoners’ office was always manned, so that the public could be reassured that, whatever time of the day or night, they could always count on finding a friendly face in the hospital, someone ready to offer a helping hand.

Half past ten on the morning of 5 January, three days after the birth of Charlotte’s infant daughter, found Alice escorting a reluctant Hetty Woods up to the chest ward.

After booking her in with Nell at the main reception desk, the almoner led her along the corridor to a small, tucked-away waiting area, its rows of benches packed with other patients. Several glanced up, their faces glum. Alice guided Hetty to the end of one of the nearest benches and supported her arm as she lowered herself between an elderly gentleman with a hacking cough and a younger woman in a wheelchair. Hetty wrung her hands in her lap and looked up anxiously at Alice. ‘Are you sure you don’t want your husband with you, Mrs Woods? I’m happy to fetch him for you before I head off.’

The woman waved the suggestion away with a flap of her hand. ‘No, he’ll only fuss and make it worse. And please, call me Hetty.’

Several patients turned in unison at the sound of approaching footsteps. At the appearance of Dr Harland, one or two gathered their belongings and gave him a hopeful look. He scowled when he caught sight of Alice. ‘Right, come this way,’ he said, exhaling loudly before striding off. One of the women clucked in annoyance as Alice helped Hetty to her feet, another mumbling something about jumping the queue.

‘Well, I’ll leave you with the doctor now, Hetty,’ Alice said when they reached the examination cubicle where Dr Harland was waiting.

The elderly woman gave her an anxious look. ‘Actually, duck, I wouldn’t mind a bit of company, if you can spare the time?’

The almoner looked at the doctor, who sighed in reply and said: ‘You won’t mind if a few students sit in on this, will you?’ It was a statement rather than a question, and as Alice guided a pale-faced Hetty up onto a couch and into a half-reclined 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.