A Grumbling Appendix

It was a sunny day in August 1917. From where he lay, Tom Mansfield could see part of the sandbagged parapet of the frontline trench and, beyond, tufts of grass on no man’s land. The midday meal had just been served out and he could smell onions and stew above the scent of wood smoke from the company cooker.

Here, the day was unusually quiet, but from ten miles north he could hear the endless rumble of artillery from the Ypres salient. From not far away, a bird he took to be a lark was trilling its way upwards. Tom lay on a stretcher in his little aid post—a cave dug into a chalk-soil bank plus a stretched tarpaulin. From here, most times, he looked after the medical needs of his battalion. Today, though, he lay in agony.

Tom’s medical course had been shortened by the urgency of war, and his hospital experience was a hurried year, but he knew enough to understand his own problem. Colicky pain all round his belly had awoken him; vomiting instead of breakfast; and now the pain had settled down into his right side. He’d seen a few patients with appendicitis, and tried to forget a post-mortem he’d watched.

He supposed that he’d be sent back to a base hospital for an operation, which meant deserting these officers who’d become friends, and the troops who seemed to depend on him. With his head on a rolled blanket, he went back to sleep. He woke to three loud explosions, and after seconds of silence, a skittering on the baked clay path. A small, fat fox terrier raced in, leapt onto his stretcher and pushed a nose under his shirt.

A moment later, he heard voices and two men came in—his sergeant, Arnie Grover, and Tiny Baker, medical officer from the neighbouring battalion. “Got the doc for you, Tom,” said Grover.

Tom grinned at the enormous Baker. “Thanks, Tiny! Don’t need your help, I know what’s wrong.”

“Well, that’s just your idea, Tom. You’re just another bloody patient, and I’m going over you, full history and examination, including per rectum. This little dog. Get him out of the way, would you mind, sergeant?”

“She’s a she,” Tom muttered. “Queenie. Terrified of shelling.”

Some time later, while Sergeant Grover stood by, Baker sat on the end of Tom’s stretcher, lighting a cigarette. He smiled at Tom, now nursing Queenie. “Yes, you’re right for once. It’s an appendix and you’ll have to go back and have it whipped out.”

The next few hours were of packing, last-minute instructions and farewells, then a painful and bumpy ride and unloading at the Casualty Clearing Station at Hazebrouck. A British medical major had a look at him, and then a tall colonel. By now he was feeling a little better, and they decided to watch him overnight.

“You realise who that colonel was?” an orderly asked Tom. “That’s George Gask. He was the top surgeon at Barts!”

Next day Colonel Gask was back. After some pushing and questioning, he said, “Australian, aren’t you?”

“Yes, sir. You’ve met a few, have you?”

“Married one. Now look, lad, from what you’ve told me, you have what we call ‘a grumbling appendix’. Settled this time, but if we leave it, it’ll get you again at just the wrong time. I’m getting you two months study leave. You’ll go to a big hospital in the West of England, in Cartan­-Reese’s department. You can learn surgery from him for a few weeks, and have him whip your appendix out. He has a great reputation for belly surgery.”

The next few days took Tom in reverse through places he’d passed three months before with excitement and dread—the crowded base of Boulogne, the Channel and Dover. Then there was a long wait, and two trains. He carried his small valise up the wide front steps of the hospital.

The heavy front doors opened and a porter greeted him. “You’d be Captain Mansfield. You’re just in time for breakfast, sir.” Through darkened corridors, the scent of breakfast and into a chattering dining room.

Four young men sat at a table. From the end, one raised his red head from over a plate of bacon and eggs, broke into a wide grin and stood up. “Hullo! You’re Tom, aren’t you? We expected you last night. Have a seat.” The others stared at him. “I’m Jim Bland, medical registrar, these two half-wits, Jack Marsh and that one George Clay are only surgical registrars, and here”—pointing to another whose left sleeve was empty—“Alec Gee, our radiologist.”

“So, you’re here to learn a bit of surgery, is that right?”

“Yes, and to suffer a bit. They want me to have my appendix out.”

Tom noticed Marsh exchange glances with Clay, before saying, “Perhaps you’d like to come on a ward round with me this morning? The Chief operates in the afternoon.”

On their walk to the ward, Marsh asked Tom, “What’s it like, out there with a battalion?”

“Tell you the truth, I’m scared the whole time. Don’t have to go out on patrols, or digging posts for wire like the others, but we get shelled. Our colonel and the adjutant last week—just sitting at a desk, then, bang! and both match-wood. I’m as scared as my little fox terrier, but nobody to run to.”

“Well, thank God, when I qualify, I’ll go to a base hospital and miles behind.”

“What about Alec Gee?” Tom asked. “What happened to his arm?”

“Always wanted to be a surgeon. But not after the Somme, last year.”

In their long walk through the corridors they passed nurses, singly and in groups, all of great interest to Tom, long confined to male company. “Yes, they’re very nice,” said Marsh, “but wait till you see Jeannie Martin, our theatre sister!”

In the afternoon, Jack Marsh led Tom to the changing room in the theatre block. There were two older men, both now changed into ill-fitting green cotton tops and trousers. The nearer one, short and scowling, was saying to the other, “If you want my advice, that fool Haig should push them back past Passchendaele.” “He’d welcome your advice, Arnold! Send him a letter!” said the taller surgeon and left the room.

“Sir Arnold!” Marsh said. “This is Captain Mansfield. Tom, Sir Arnold Cartan-Reese!” Cartan-Reese ignored Tom’s extended hand and spoke to Marsh. “Yes, got a letter from Gask. He’ll be a nuisance, but get him to scrub up.”

As they scrubbed up together in the operating theatre, Jack Marsh said, “That’s typical of him. Ooh! Look who’s here!! Jeannie, here’s our hero, back from the trenches—this is Tom, I told you about.”

“Hullo, Tom. So nice to have you here.” Her voice was soft, and Tom took from her voice and her look that his presence was about the best experience of her life.

First on the list was a very fat woman whose gall-bladder was to come out. Cartan-Reese made a bold slash, a hand’s span long, beneath the right ribs. With retractors, Tom pulled the lower rim of the wound down and Marsh pulled the top upwards. A hand went under the liver edge, and, after a few movements, came back gripping a dark green bag. “Give me the Duvals!”

“Sorry, Sir Arnold, we’ve only got the Hawkins,” said Sister Martin.

“But I want the bloody Duvals!”

“Sorry.”

“Stuff sorry! These Hawkins won’t do! Where are the Duvals?” He pelted the Hawkins forceps to the floor.

In a quiet voice, Sister Martin said, “Oh dear! These new gloves are so slippery. Nurse Alford, boil those Hawkins forceps, please.”

Tom and Jack Marsh took their retractors out and put a hot towel on the wound.

After an interval, the forceps came back steaming and the operation went on, without a word. The cystic artery and cystic duct were tied, the gall bladder was in a specimen jar. And as Cartan-Reese left the theatre, Jack Marsh was sewing up the wound in layers.

A few nights later, Tom knocked on Jack Marsh’s door, in answer to an invitation. To his surprise, Jeannie was sitting on a couch. A few glasses later, Tom noticed that the two were holding hands. “We’re worried about you, Tom,” said Jack. “I mean about your operation.”

“Well, I’ve thought about it, too. But you know the old saying, that ‘You’d be better cut by a horrible bastard who is dexterous, than by a nice chap with no touch’.”

“I don’t think that works. See, he’s dexterous enough. You’ve seen that for yourself. It’s not his hands you need to worry about. It’s his head.”

Jeannie spoke. “He’s opinionated, he’s ill-tempered, and without any judgment.”

“We think he’s well-nigh mad,” said Jack. “International reputation and all. He’s absolutely heartless, doesn’t care a damn for his patients, either in deciding to operate, or looking after them when things go wrong. Things do go wrong. We all know that. But just try to get him back to help.”

Over the next few days, Tom felt trapped and uncertain. He decided in the end that there was not much risk of ill-judgment in the decision to operate, the procedure itself, or the after-care. He would let things roll.

Now it was September, and he woke to the luxury of sheets and warmth, silence, and—above all—the enormous pleasure of not being a target for casual shelling. He thought of his friends at the battalion, if any more had gone, and if they were in the Menin Road battle. But these thoughts were faint and far away. He thought of Jeannie, but then decided that he’d better not.

Prospects for today came with a surge of pleasure. He now worked with Lionel Hamley, the tall surgeon from the changing room. Lionel had been sent back from Mesopotamia with some lung problem. He could not be drawn on his experiences out there, beyond, “If they ever offer you Mespot, Tom, then politely decline.” Now a civilian again, he was a pleasure to watch working, and a born teacher.

During a break, Jack Marsh asked Tom, “How’s your new boss?”

“Well, Lionel’s versatile. He tackled a compound femur, trephined a skull and took out a spleen—all in the last week. And he’s good in the wards, too. That chap who’d had the spleen. Next day we’re doing a round, four beds away. Lionel looks across and says to me, ‘That man’s bleeding somewhere!’ And, sure enough, we had to take him back to theatre. He’s so damned sharp, I think he could read your mind.”

Before a Wednesday afternoon’s operating list, Hamley and Cartan-Reese met in the changing room. “Bit of an honour, Lionel,” Cartan-Reese said. “I’m giving the Halloran Memorial Lecture in Birmingham on Friday night, and staying with Lord Moynihan and his family over the weekend. I’ll be back on Monday afternoon.” Hamley congratulated him.

On the Saturday morning, Hamley took Tom, a junior resident and six students on a round of his surgical ward.

At morning tea, as Tom reached out for a buttered scone, Hamley laid a hand on his arm and said, “Better not, Tom. You don’t look a bit well.”

Tom took his hand back, and stared, puzzled.

“And you woke up with a pain all over your belly?”

Tom caught the trace of a smile on Hamley’s face. “That’s right, and I’m pretty nauseated. Think I’ll head for bed.”

A little later, Hamley sat on the edge of Tom’s bed. “Are you tender there?”

“I certainly am. Oh, damn! Looks like another acute attack.”

As Tom lay on the operating table, and the anaesthetist held chloroform ready, Hamley said to him, “Nick of time, eh, Tom?”

From the railhead, Tom rode to the battalion in a truck crowded with reinforcements—boisterous and anxious, all seeming to him about sixteen.

He’d written to Colonel Gask, thanking him for the leave and explaining the urgent operation. Noticing the chill, he was pleased to carry the fur-lined gloves and greatcoat he’d bought in London. He dreaded a repeat of a winter like 1916.

He thought, not proudly, of his minor triumph in dodging an operation by Cartan-Reese. Then he felt bad that he’d done nothing for the hundreds of trusting patients still to fall under the man’s impetuosity and misjudgment.

Back at the battalion, now five miles further east, he visited the new colonel and adjutant. The September offensive had cost the lives of Jack Adams, who commanded B Company, two young lieutenants and thirty other ranks, of whom he had known quite a few.

Sergeant Grover greeted him warmly, and took him to the regimental aid post. On the way he asked Grover, “Where’s Queenie?”

“Well, she looked for you everywhere, and then she stopped eating. There she is.” He pointed to a small earth mound.

“What’s wrong with me?” Tom mused. “I took the death of those friends calmly, and now this brings me to tears. Hamlet had it right—the time is out of joint. And I’m back to where bad things happen, undeserved things. I suppose they’ll go on happening next year and the year after next.”