“Are you alright, sir?”
The librarian’s enquiry had been intoned with practised reverence and addressed to Justin, who sat at a table in a Reference section of the Library of Birmingham, surrounded by opened and discarded books. He was slumped forward, his head resting on his arms. His unkempt hair fell in profusion across his forearms and over his open books. The librarian winced visibly at the stale body odour and old smoke stench that emanated from the apparently sleeping Justin. He slowly raised his head and turned to observe her. He saw a plump, youngish woman with hair scraped back and glasses hanging round her neck from a metal beaded chain. They nestled on an ample bosom disciplined by tailored and darted clothing. Her cheeks were rosy and there was a downy shadow from her hairline towards the curve of her jaw. She regarded him quizzically while her lips pursed slightly in involuntary disgust and an effort not to breathe too deeply.
She had watched him closely as he entered the library. At first she wondered if he were a student but on closer examination, as she had followed his hesitant movements on a CCTV screen, there was about him, she decided, a furtiveness and edginess she associated with hostile or ‘unwell’ people. She was glad of the emergency buzzer under her desk that linked directly to the local police station. And he was so dirty! Actually, close up, quite disgusting. She wanted him gone. “Are you alright, sir?“ She repeated less politely.
Justin nodded and scowled at her. He began hastily to close the reference books but not before she caught their titles: “The Preparatory Manual of Explosives: Fourth Edition’, “Explosives”, “The ultimate book of Explosives”. It occurred to the librarian that these books were crudely named and irresponsibly stocked in such an eminent institution as The Library of Birmingham. Hard on this thought came a sting of fear. This man was very possibly dangerous. She noted that his hands were shaking violently as he grappled with the books. “Don’t worry, I’ll put those away for you, sir, “ she spoke in an even lower voice, tried to smile at him, but he wouldn’t look at her. To her relief, however, he stopped fumbling with the books and tried to stand. He was clearly having trouble coordinating his movements. She took a step or two back and watched Justin attempt to rise from his chair, fall heavily back onto the seat. Her eyelids fluttered in consternation. “Are you alright?”
Suddenly, on his third attempt to rise, Justin cried out in apparent anguish or pain. His hands flew to his head as his knees crumpled and he fell to the floor. Several readers or seekers of books turned abruptly or appeared from behind shelves, to discover the source of the startling noise. Justin was rolling on the floor, curled into a foetal shape, his face contorted in what looked like agony. The Librarian became increasingly agitated. All eyes were now on her, expecting her to suggest a course of action.
“Shall I call someone?” she said out loud, eventually, as much to the growing assembly of library users as to Justin. A bespectacled young man in her direct eye-line nodded vigorously, followed the action by producing a mobile phone from a jacket pocket and extending it to the librarian. When she didn’t take it but looked pleadingly at him he dialled and held the phone to his ear. Justin cried out again, rolled on the floor, pulled his knees closer to his head as though he would curl in on himself and disappear. Like a smelly hedgehog, thought the librarian. Then, as if following another sudden thought, she gathered up the books Justin had been reading. His fingerprints would be on them. When they were piled neatly, she placed them under one arm. A young woman knelt beside Justin and was trying to make soothing contact with him. She placed a tentative hand on his shoulder. Justin seemed oblivious to all but his own excruciating pain. And then, he was silent and all the tension left his body as he passed into unconsciousness.
“He’s bleeding!” exclaimed the young woman at his side, “There’s blood coming out of his nose.”
“There’s an ambulance on the way,” announced the bespectacled man. “About ten minutes, apparently.”
“Very good. Thank you,” said the librarian, watching the blood slipping from Justin’s nose and pooling briefly on the Reference Section carpet. That, she thought, will not clean easily. She said aloud, “Best not to touch him – he’s on his side.” And she turned briskly in the direction of her desk. She would be waiting with the books, ready to hand them over to whatever authorities came to take away this alarming young man. But first, she had to make a formal log of their reference numbers and check them out. After all, they would only be out on loan – she should make that clear.
At around four o’clock, Mr. Gabor Kovacs received a telephone call from a Ward Sister at the King James Hospital. As he held the receiver to his head, he frowned in the effort to follow the information and work out his feelings. He focused on the important details of what the Sister was saying and made appropriate responses to indicate his comprehension but was, throughout, perplexed and eager to get off the telephone. Justin, his son, whom he had not seen for almost two years, had been admitted to the Emergency Ward of the King James Hospital, about an hour ago. He had collapsed in the Birmingham Library. Severe headaches, apparently. The paramedics had found a national insurance card in one of Justin’s pockets and traced him to his last address.
Mr. Kovacs thanked the Ward Sister mechanically and put down the phone, free at last to explore his thoughts. Justin was seriously ill. Probably drugs, was Mr. Kovacs’ uppermost thought, probably an overdose. He had always suspected this was how Justin would die. But the reality was brutal. Gabor Kovacs’ eyes flitted to the school photo still on the wall. Justin aged fourteen. Smiling, clean cut, handsome, eyes sparkling with youthful health and innocence.
“Nora,” he shouted to his wife, who was in the kitchen and listening to some radio programme on gardening, “we must get to the hospital quickly. It’s our Justin. He’s very sick. I’ll get the car out of the garage. You get your coat on.”
The paramedics relayed as well as they could to the medical staff, the account of Justin’s decline from relative health to unconsciousness, as observed by the librarian. She had ended her account by trying to hand the paramedics the books Justin had been reading when taken ill. “Keep them for the police, love, if they want them. OK? Can’t take them now. Got to get the patient to hospital.” The librarian had nodded tersely, placed the books beneath the counter. She could wait.
Justin was still bleeding from his nose when admitted. Preliminary examinations by the duty doctor could not establish an obvious cause of the great pain that had apparently assailed this man and the condition that caused his lack of consciousness. His pupils were responsive to light and the doctor ordered blood tests and an emergency CT scan. The time was two forty-five on Sunday afternoon.
The patient’s wallet contained two very grimy photobooth shots of a middle aged couple, heads close and smiling broadly into the camera. There was also a five pound note and a National Insurance number card. The name etched in relief beneath the number cross referenced to hospital computer files from over twelve months earlier. These indicated Justin was a past trauma patient, admitted with a knife wound which had needed forty stitches. From there, it was easy to confirm his identity; the livid scar running jagged across his upper arm was a distinguishing feature.
“We have a positive id,” pronounced the male nurse who wheeled Justin’s inert body into the Radiotherapy department. “Justin Kovacs, twenty. Vagrant. Suspected head trauma of some sort. May be drugs related. We’re waiting for bloods.” He then pinched his nose and made an expression as if to warn the radiographer of bad odour and pointed to Justin. She smiled broadly and rolled her eyes.
“Great,” she announced, “just what I need at the end of a Sunday shift.”
The bed opposite Jonathan was vacant and clearly being prepped for receipt of a patient. A nurse brought an oxygen trolley, left it beside the bed then produced a pen from a uniform pocket and wrote on the whiteboard above the bed head in large black letters, ‘JUSTIN KOVACS’. Jonathan wondered if this was the reason his three o’clock scan had been postponed. Once she had finished turning back the bed, the nurse crossed to Jonathan and asked how he was feeling and checked his observation chart. Actually, he was feeling very unwell. Trying to hide his panic at the increasing volume of the voices in his head and the pain gathering force like successive tidal waves, he attempted a wan smile in response to her question. She regarded his dilated pupils, the perspiration on his forehead and took his left his wrist between her thumb and forefingers. His pulse was racing.
“Are you in pain, Mr. Graham?” He couldn’t answer. Normally, he would have escaped from possible inquisition by now, found the nearest toilet cubicle or empty room and tried to sit out the attack. In this hospital ward, subject to close observation, this was impossible. Suddenly, he had to double forward and take his head in his hands. It was all he could do to stop himself crying out in agony as the pain reached a crescendo. The voices, as usual, pronounced him an idiot to believe the material could be affected by the immaterial and shouted aggressively that if God were real, why was He allowing the Professor to suffer like this? Beyond that, there was just incoherent, sustained noise at a frequency amounting to intolerable pain. Jonathan was unaware of the nurse’s actions as she pressed the emergency button by his bedside and a doctor and another nurse appeared within seconds.
As Jonathan lost consciousness for the second time that day, there ensued among the attendant medical staff, an urgent conversation the conclusion of which, was that it was imperative to get this man into a CT scanner without further delay.
“Emergency, Rebecca, got to get this patient into the scanner now or as near to now as possible.” A young male doctor addressed the senior radiographer and thrust at her a file containing Jonathan Graham’s notes. She regarded him with undisguised irritation.
“A little busy right now, Doctor?” she looked at him, left him to put the notes on a desk and turned back to the scan in progress.
“Right. Yes. Sorry. How long will this one be, do you think?” Rebecca did not answer at first. She had found a definite area of tissue damage in the right temporal lobe of Justin Kovacs’ brain, a lesion that was certainly the source of the bleed from his nose. A medic would confirm, but Rebecca had seen enough damaged brain tissue, tumours and lesions in her two decades of radiography experience to know this was serious.
“Is Doctor Jenkins on her way?” she said eventually to the impatient young doctor who was also now distracted by what was captured on the CT screen.
“Hm? Yes. Yes I paged her straight away. She’s coming.”
“Good,” pronounced Rebecca in a tone which indicated that her relief at the prospect of dealing with Dr. Jenkins was personal as well as professional.
Within a few minutes, Doctor Jenkins arrived. “Goodness, Rebecca, bit busy for a Sunday afternoon in here!” she quipped. Rebecca moved aside to allow the doctor full view of the CT screen. There was a moment’s pause while both women looked at the junior doctor and waited for him to move aside. “Interesting,” pronounced Dr. Jenkins, “there’s atrophy around the lesion – he’s been having trouble for some time, I’d say. The blood supply to this area of his temporal lobe is quite restricted. We need to get him to surgery, see what’s going on.”
After a few moments’ silence, she spoke her thoughts aloud, half distracted as she continued to scrutinise, enlarge, scrutinise, rotate the image before her, “Hang on...looks like there might be...something ...can’t be certain...wait...” She turned to the junior doctor and smiled briefly at him, “Dr. Rigby, please contact the on-call Neurologist – emergency. “ She raised a hand to prevent his protestation as it was forming, “Don’t know for sure, please find out. Schedule surgery – right frontal lobe lesion, some tissue atrophy, local bleed – prep theatre six, please.” Then she turned back to the screen and without taking her eyes from it, addressed the radiographer. “I’m pretty sure there’s a foreign body of some sort here...very tiny. We need to get in and take a look. Do we have this patient’s notes?” She straightened up, addressed a nurse behind her.
“Not sure – apparently he was admitted last year for a knife wound. A&E. He’s homeless.”
“Can you follow up, please? Let’s try and get this guy’s medical history.” Dr. Jenkins smiled at the nurse, then widened her eyes as if to indicate ‘now, would be good’.
“Sure,” and the nurse picked up the telephone in the CT booth, rang through to admin, began the document trail. Doctor Jenkins then turned to the Radiographer.
“When she’s finished on the phone, Rebecca, please ask her to get the patient to the Emergency Ward – we’ll prep him there. There’s some movement- I think he’s coming around. Can we keep him calm?” She spoke again to the nurse just as she was ending her phone call, “Pre- med routine, soon as, please – we really can’t have him agitated in his condition and he’s got no idea where he is. Try and soothe him – oh, and nurse, do your best to clean him up a little before surgery, would you?”
“Now,“ Dr. Jenkins looked beyond the CT control room to the second gurney visible through the window, “let’s see what’s going on in this gentleman’s head.” Then, back to the radiographer, ”Soon as this guy’s clear, please, can we have the waiting patient transferred to the scanner?” Rebecca assented. At some stage, she would need to find time to leave the department and make a phone call to her husband and ask him to take her Sunday lunch out of the oven before it too atrophied.
Jonathan awoke gradually, free of pain, to a merciful internal silence. As soon as his eyes opened, he became aware of voices around him and a fair amount of activity close to where he lay. A brief survey of his environment told him he was in Radiography. A slight raising of his head confirmed the suspected proximity of the CT scanner. Then the words of the staff busy with something beside him, caught his attention and he closed his eyes lest his consciousness should be detected and they lowered their voices.
“...dunno for sure, a brain lesion, temporal lobe. Doctor Jenkins thinks there’s something in there – some sort of foreign body or something. He’s scheduled for theatre this evening. Poor Rebecca – don’t think she’s getting home for ages.”
“Foreign body?” came a surprised response from the male nurse who had wheeled Justin down to Radiography in the first place, “How can that be?”
“I don’t know. They won’t be sure till they get in there – might be a tumour, or something from a previous injury – been there a while. He’s been having terrible headaches and...”
“Justin?” the male nurse’s voice cut her off, was louder now. “Justin, just relax, mate – you’re in hospital.”
Jonathan lay quietly on his gurney, opened his eyes as an orderly began wheeling him towards the CT scanner and Dr. Jenkins appeared beside him, smiling down at him reassuringly.
“Ah, you’re back, Jonathan. We’re going to do that CT scan, now.”
Jonathan closed his eyes and allowed a surge of relief to wash over him. They hadn’t been talking about him.
“I know, he responded, “Stay very, very still.”
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