Doctor Frigo (9 page)

‘You’ve had it for two months?’

‘Well, for the past few weeks anyway. I thought at first that it might be the change of altitude after Mexico City, or perhaps the different pollens in the air.’

‘Do you suffer from hay-fever?’

‘Not seriously and never before at this time of the year.’

‘Have you taken your temperature?’

‘Of course. Every day. Normal. I told Massot all this. I thought he might give me an anti-histamine to clear it up. He did give me some pills.’

‘They didn’t do any good?’

‘I had violent diarrhoea for two days, if you call that good. They did nothing for my sinuses.’

‘You told Dr Massot?’

‘Of course. He told me to increase the dose. Naturally I didn’t. I threw the things away. Obviously the man was incompetent. We told Gillon so.’

‘I see.’

And I did see. Spanish-speaking persons suffering from sinus congestion or head colds commonly describe themselves as being
constipado.
With French and English-speaking
physicians who don’t happen to know that the usual Spanish word for constipated is
estrenido
this has often led to misunderstandings. But as there seemed no point in trying to salvage Dr Massot’s reputation in that household I didn’t bother to explain.

‘Do you sleep here with the air-conditioning turned up like this?’ I asked.

‘Of course.’

‘How about Doña Julia? Doesn’t she find it a little extreme?’

‘Oh she sleeps in her own room. Anyway she doesn’t like air-conditioning.’

‘The windows are well screened against insects here. Have you tried sleeping with the windows open and the air-conditioning turned off?’

‘Why should I? What is the use of air-conditioning if you turn it off? Then you get the humidity.’

‘Your sinuses might prefer it. If they didn’t you could always turn the air-conditioning on again.’

‘Very well. I will try doing as you suggest. You don’t think an anti-histamine would help?’

‘I’ll know better later when I’ve had a chance to examine you. Have you any other troubles?’

‘Yes, here.’ He put a hand on the left lower quadrant of the abdomen. ‘Pain and cramps, except that I don’t seem to have them at the moment. It is always the way when one sees doctors. Pains disappear.’

‘Any nausea, vomiting?’

‘When I had the cramps, yes. This was two weeks ago. It went away. Some sort of food poisoning I suppose. I had a little temperature, but then I often have temperatures. For no reason that I know of.’

When I had extracted as much of his medical history as I could from him I put my note-book aside.

‘Well I’d better have a look at you, Don Manuel. Would you take off your clothes?’

‘All of them?’

‘Please. And, if you agree, it might be wise if we turned down the air-conditioning a bit.’

The examination was as thorough as I could make it under the circumstances. He was completely co-operative and took a keen interest in everything I did; almost too keen. The check-up procedures employed by the American British Hospital in Mexico City were highly familiar to him and he amused himself by comparing them with mine. Examining a patient for the first time calls for a good deal of concentration. It was disturbing to have to answer his questions as I worked, even the easy ones.

Why, for instance, did American and British doctors measure blood pressure in one way while doctors with European training measured it in another?

Answer: they don’t measure it differently, they merely use different units of measurement to express the result. The Americans and the British use millimetres, the Europeans centimetres. For example, his blood pressure was 190/100 in millimetres and 19/10 in centimetres. Yes, it should be lower; but I would take it again in a little while and perhaps it would be different. Sit up please and take deep breaths through the mouth.

Not all the questions were irrelevant. As I was taking a blood specimen from him he asked if a serum thyroxine check would be done. I told him that it would.

‘You will find the figure a little high, as much as sixteen.’

‘Yes, that is on the high side.’

‘The hospital has its own laboratory facilities?’

‘We have an Institut Pasteur unit attached to us.’

‘Do you do radio-active iodine uptake tests?’

‘Not here. We get those done in Fort de France.’

‘Don’t trouble about it in my case. I had the test done six months ago. Everything okay.’

‘I’m glad to hear it.’ Later I said: ‘I must ask you to come into the hospital for X-rays, Don Manuel. Just for an hour or two.’

‘The lower bowel?’

‘It’s probably nothing to worry about, but we’d better be sure. We can do some other tests at the same time.’

‘Well you don’t have to worry about kidney function. I had a serum creatinine done at the same time as the iodine uptake. Point nine milligrams per cent. Nothing wrong there.’

‘It doesn’t sound as if there is, no.’

He watched me closely, sitting on the bed in his underpants, as I packed away the various specimens I had taken.

‘These X-rays you want. Are they absolutely necessary?’

‘I’m afraid so. You see, these abdominal pains you complain of – you didn’t have them when you were in Mexico, did you?’

‘I had good health in Mexico. When will you know about the tests you’re doing?’

‘I will have some results tomorrow, the rest the day after. If I may telephone when I have them all we can perhaps arrange another appointment for me to give you my report.’

‘What about the X-rays?’

‘We can arrange for those by telephone also.’

‘Very well.’ He went to the nearest windows and flung them open. ‘Hot and sticky,’ he commented as the air from outside came in. ‘I hope it pleases you, Doctor.’

‘I hope you sleep well tonight, Don Manuel.’

He got the tissue box from his desk. When I left he was blowing his nose vigorously.

Uncle Paco called to me from the terrace as I reached the bottom of the stairs.

I went in and sat down facing him. An iced rum drink stood in the arm recess of his chaise longue. He pointed to it.

‘Do you want one of these, Ernesto?’

‘No thank you. I have to go back to the hospital.’

‘Well?’

‘As I have told Don Manuel it will be a day or two before I have the test results. I shall also want him to come to the hospital for X-rays.’

‘What’s the matter with him?’

‘With his nasal passages, excessive air-conditioning. I told him to try sleeping with the windows open. That may or may not be good advice. I’ll know in a couple of days.’

‘And what else?’

‘I don’t know, Uncle Paco. I hope to find out. If there is anything to find out, that is. Meanwhile, there is one question I didn’t ask him. I thought I’d ask you instead.’

‘Well?’

‘How much alcohol does he drink?’

‘Your colleague Massot asked me the same question. I don’t think he believed the answer he got from Don Manuel himself. The answer is none at all.’

‘No wine, no beer? Nothing?’

‘No alcohol. By that I mean rum, whisky, vodka, gin, brandy, tequila – alcohol. He drinks wine in moderation, beer occasionally. It’s the slight slurring in his speech that you’re talking about, isn’t it?’

‘Yes.’

‘His thoughts sometimes race ahead of his capacity to translate them into words. It is an old failing of his. Or a strength some might call it, an asset. With some men whose minds work like lightning, ahead of their speech, the result is a stammer, or even incoherence. With Don Manuel it is elision of some consonants. Delivering a prepared speech, when he knows in advance what he is going to say, his diction is impeccable. But try to explain such a thing to Dr Massot!’

‘I see what you mean.’

Uncle Paco beamed. ‘I’m so glad, Ernesto.’

‘You said that it’s an old failing of his. How old?’

‘Ever since I’ve known him. Now tell me, Ernesto. Be frank. You liked him? It’s important, you know. He wants you on his side. Oh, I don’t mean just politically, but for the sake of the past.’ He heaved himself forward on the chaise and took a swallow of his drink. ‘I will tell you something in confidence. When he knew that you were to be his doctor he confessed to being ashamed.’

‘Of what?’

‘Of what indeed! You may well ask, as I did. Do you know what he answered?’

‘I can’t imagine.’

‘He was ashamed because when your father was murdered by those hoodlums, he, Don Manuel, was being wined and dined far away in New York. He even went to bed and slept. It wasn’t until he saw the morning newspaper hours later that he knew. He still remembers, you see. He is a sensitive man. He has a heart, Ernesto.’

‘I’m sure he has. So he had to read about it in a newspaper.’

‘In New York how else would he find out?’

‘You’re behind the times, Uncle Paco. Even twelve years ago most New York hotel rooms had television sets. According to Don Manuel there was a news flash after which he called the embassy in Washington for confirmation. Not that it matters how he heard the news. The important thing is, I gather, that he was far away in New York at the time and in no way involved with what was happening at home. Is that right?’

We stared at one another for what seemed a long time, then I went to the bell and rang it.

When Antoine came Uncle Paco told him to show me out. That was all. We didn’t say another word.

The following is the report I wrote up from my notes when I got back to the hospital. It was written as a preface to the hospital case history and for inclusion in the medical dossier normally kept on every patient treated here.

VILLEGAS
Lopez, Manuel.
Age 51. Civil engineer, politician.

Family History.
Father died age 49, probably of peritonitis. Mother still living and well, aged 73. Has one sister living and well. Married: two sons, one daughter.

Personal History.
Appendix removed age 25. Patient had urinary tract study carried out in Mexico City (A B Hospital?) 6 years ago. Intravenous pyelograms were made. Study appeared normal. Doctor told him he had probably passed gravel two weeks earlier.

Cardio-respiratory history negative. Has a little arthritis, occasionally helped by physiotherapy.

Complains of pain left lower quadrant, nausea, abdominal distension and cramps, malaise. Also unexplained fevers. Symptoms not now present, having ‘gone away’ two weeks ago.

No dysuria, no haematuria. No history venereal disease. Former tests (also Mexico City) negative.

On examination.
Extra-ocular movements were normal. Pupils are round, regular, reacted to light and accommodation actively. Ears negative. Patient has some sinus congestion. Pharynx clear however. Teeth in fair condition. Gums not inflamed. Thyroid not enlarged. No adenopathy. Thorax full and rounded. Breasts normal. Lungs clear to percussion and auscultation. Pulse 96. Temperature 37.4. Respiratory rate 22. The blood pressure was taken several times. Range was from 19/10 to 16/9.5. Cardiac rhythm was regular. Appendix scar. Liver and spleen not enlarged. There was tenderness over McBurney’s point. No hernia but right inguinal ring appeared to be widely patent. Rectal tone was normal. Extremities well-formed symmetrical. Back straight. Feet normal. Knee kicks and biceps were equal and active. Babinski and Romberg negative. Kidneys normal to palpation. No costovertebral tenderness. Bladder negative. Penis and testes normal. Prostate soft, benign.

Blood and urine specimens taken.

Patient said radio-active iodine uptake test made Mexico. No abnormality found. Serum creatinine test (also Mexico) also stated to be satisfactory.

Informed patient necessity X-ray examinations.

Preliminary findings.
Diverticulosis. Possible diverticulitis. Hypertension probably connected patient’s political activities and related emotional factors. Mild thiazide therapy should be considered.

Other observations.
Patient has slight speech impediment involving slurring of consonants. Patient seems conscious of difficulty and endeavours correct it. Not always able to do so. Said to be very light drinker. Saw no reason to doubt this.

N.B. According to P. Segura, friend of patient, impediment is of long standing and due inability speech faculty to keep pace with mental process. Patient’s awareness impediment and partial ability to control or correct seems contradict Segura’s view.

Signed:
Castillo

That was written on Tuesday afternoon.

Later I spoke to Dr Brissac who in turn spoke to the technician in charge of the X-ray department. As a result (the X-ray department is always overworked and under-staffed) I was able as a favour to obtain a choice of appointments for Villegas - 10.00 hrs on either Thursday, Friday or Saturday.

I then telephoned Les Muettes and asked to speak to Don Paco. Instead I was given Doña Julia.

She promised to let me know by the following morning which appointment would be acceptable, and did so. That was on Wednesday 14. The appointment chosen was for Friday morning. On her husband’s behalf she asked if the results of the tests taken were then known. I said that I would go through the results with him when I saw him at the hospital on Friday.

On the morning of Thursday 15 the manservant Antoine telephoned to say that Villegas would not be keeping the Friday appointment. No reason given. I asked if Villegas
was ill and was told that he was not. I also asked if he wished to make a later appointment. Antoine did not know.

I informed Commissaire Gillon by telephone of the situation. He informed me, in turn, that he had just received by hand a letter from Paco Segura.

The letter informed him that neither my services nor those of any doctor were at present required by Señor Villegas or his family. Their health was excellent. In case of need, or in an emergency, Commissaire Gillon would at once be informed. Meanwhile he could be assured of Señor Segura’s distinguished sentiments.

Gillon was understandably annoyed.

‘Well, Doctor,’ he said curtly, ‘what’s gone wrong?’

‘I don’t know.’

‘What about these stomach X-rays that you had arranged for? Are they important? Urgent?’