A.J. Cronin

In this excerpt from The Citadel, Andrew Manson, newly out of medical school, has just begun his medical practice as an assistant to Dr Edward Page in the small Welsh mining town of Blaenelly. As he is returning from a disappointing evening with Christine, the girl he loves, he is met by Joe Morgan. Joe and his wife, who have been married nearly twenty years, are expecting their first child.

Though it was nearly midnight when Andrew reached Bryngower, he found Joe Morgan waiting for him, walking up and down with short steps between the closed surgery and the entrance to the house. At the sight of him the burly driller’s face expressed relief.

“Eh, Doctor, I’m glad to see you. I been back and forward here this last hour. The missus wants ye—before time, too.”

Andrew, abruptly recalled from the contemplation of his own affairs, told Morgan to wait. He went into the house for his bag, then together they set out for Number 12 Blaina Terrace. The night air was cool and deep with quiet mystery. Usually so perceptive, Andrew now felt dull and listless. He had no premonition that this night call would prove unusual, still less that it would influence his whole future in Blaenelly.

The two men walked in silence until they reached the door of Number 12, then Joe drew up short.

“I’ll not come in,” he said, and his voice showed signs of strain. “But, man, I know ye’ll do well for us.”

Inside, a narrow stair led up to a small bedroom, clean but poorly furnished, and lit only by an oil lamp. Here Mrs Morgan’s mother, a tall, grey-haired woman of nearly seventy, and the stout, elderly midwife waited beside the patient, watching Andrew’s expression as he moved about the room.

“Let me make you a cup of tea, Doctor, bach,” said the former quickly, after a few moments.

Andrew smiled faintly. He saw that the old woman, wise in experience, realised there must be a period of waiting that, she was afraid he would leave the case, saying he would return later.

“Don’t fret, mother, I’ll not run away.”

Down in the kitchen he drank the tea which she gave him. Overwrought as he was, he knew he could not snatch even an hour’s sleep if he went home. He knew, too, that the case here would demand all his attention. A queer lethargy of spirit came upon him. He decided to remain until everything was over.

An hour later he went upstairs again, noted the progress made, came down once more, sat by the kitchen fire. It was still, except for the rustle of a cinder in the grate and the slow tick-tock of the wall clock. No, there was another sound—the beat of Morgan’s footsteps as he paced in the street outside. The old woman opposite him sat in her black dress, quite motionless, her eyes strangely alive and wise, probing, never leaving his face.

His thoughts were heavy, muddled. The episode he had witnessed at Cardiff station still obsessed him morbidly. He thought of Bramwell, foolishly devoted to a woman who deceived him sordidly, of Edward Page, bound to the shrewish Blodwen, of Denny, living unhappily, apart from his wife. His reason told him that all these marriages were dismal failures. It was a conclusion which, in his present state, made him wince. He wished to consider marriage as an idyllic state; yes, he could not otherwise consider it with the image of Christine before him. Her eyes, shining towards him, admitted no other conclusion. It was the conflict between his level, doubting mind and his overflowing heart which left him resentful and confused. He let his chin sink upon his chest, stretched out his legs, stared broodingly into the fire. He remained like this so long, and his thoughts were so filled with Christine, that he started when the old woman opposite suddenly addressed him. Her meditation had pursued a different course.

“Susan said not to give her the chloroform if it would harm the baby. She’s awful set upon this child, Doctor, bach.” Her old eyes warmed at a sudden thought. She added in a low tone: “Ay, we all are, I fancy.”

He collected himself with an effort.

“It won’t do any harm, the anaesthetic,” he said kindly. “They’ll be all right.”

Here the nurse’s voice was heard calling from the top landing. Andrew glanced at the clock, which now showed half-past three. He rose and went up to the bedroom. He perceived that he might now begin his work.

An hour elapsed. It was a long, harsh struggle. Then, as the first streaks of dawn strayed past the broken edges of the blind, the child was born, lifeless.

As he gazed at the still form a shiver of horror passed over Andrew. After all that he had promised! His face, heated with his own exertions, chilled suddenly. He hesitated, torn between his desire to attempt to resuscitate the child, and his obligation towards the mother, who was herself in a desperate state. The dilemma was so urgent he did not solve it consciously. Blindly, instinctively, he gave the child to the nurse and turned his attention to Susan Morgan who now lay collapsed, almost pulseless, and not yet out of the ether, upon her side. His haste was desperate, a frantic race against her ebbing strength. It took him only an instant to smash a glass ampule and inject the medicine. Then he flung down the hypodermic syringe and worked unsparingly to restore the flaccid woman. After a few minutes of feverish effort, her heart strengthened; he saw that he might safely leave her. He swung round, in his shirt sleeves, his hair sticking to his damp brow.

“Where’s the child?”

The midwife made a frightened gesture. She had placed it beneath the bed.

In a flash Andrew knelt down. Fishing amongst the 

sodden newspapers below the bed, he pulled out the child. A boy, perfectly formed. The limp, warm body was white and soft as tallow1. The cord, hastily slashed, lay like a broken stem. The skin was of a lovely texture, smooth and tender. The head lolled on the thin neck. The limbs seemed boneless.

1 the hard fat of animals melted and used to make soap, candles etc.

Still kneeling, Andrew stared at the child with a haggard frown. The whiteness meant only one thing: asphyxia, pallida2, and his mind, unnaturally tense, raced back to a case he once had seen in the Samaritan, to the treatment that had been used. Instantly he was on his feet.

“Get me hot water and cold water,” he threw out to the nurse. “And basins too. Quick! Quick!”

“But, Doctor—” she faltered, her eyes on the pallid body of the child.

“Quick!” he shouted.

Snatching a blanket, he laid the child upon it and began the special method of respiration. The basins arrived, the ewer, the big iron kettle. Frantically he splashed cold water into one basin; into the other he mixed water as hot as his hand could bear. Then, like some crazy juggler, he hurried the child between the two, now plunging it into the icy, now into the steaming bath.

Fifteen minutes passed. Sweat was now running into Andrew’s eyes, blinding him. One of his sleeves hung down, dripping. His breath came pantingly. But no breath came from the lax body of the child.

A desperate sense of defeat pressed on him, a raging hopelessness. He felt the midwife watching him in stark consternation, while there, pressed back against the wall where she had all the time remained—her hand pressed to her throat, uttering no sound, her eyes burning upon him—was the old woman. He remembered her longing for a grandchild, as great as had been her daughter’s longing for this child. All dashed away now; futile, beyond remedy…

The floor was now a draggled mess. Stumbling over a sopping towel, Andrew almost dropped the child, which was now wet and slippery in his hands, like a strange, white fish.

“For mercy’s sake, Doctor,” whimpered the midwife. “It’s stillborn.”

Andrew did not heed her. Beaten, despairing, having laboured in vain for half an hour, he still persisted in one last effort, rubbing the child with a rough towel, crushing and releasing the little chest with both his hands, trying to get breath into that limp body.

2 suffocation or unconscious condition caused by lack of oxygen and excess of carbon dioxide in the blood, accompanied by paleness of the skin, weak pulse, and loss of reflexes

And then, as by a miracle, the pigmy chest, which his hands enclosed, gave a short, convulsive heave, another… and another… Andrew turned giddy. The sense of life, springing beneath his fingers after all that unavailing striving, was so exquisite it almost made him faint. He redoubled his efforts feverishly. The child was gasping now, deeper and deeper. A bubble of mucus came from one tiny nostril, a joyful iridescent bubble. The limbs were no longer boneless. The head no longer lay back spinelessly. The blanched skin was slowly turning pink. Then, exquisitely, came the child’s cry.

“Dear Father in heaven,” the nurse sobbed hysterically. “It’s come—it’s come alive.”

Andrew handed her the child. He felt weak and dazed. About him the room lay in a shuddering litter: blankets, towels, basins, soiled instruments, the hypodermic syringe impaled by its point in the linoleum, the ewer knocked over, the kettle on its side in a puddle of water. Upon the huddled bed the mother still dreamed her way quietly through the anaesthetic. The old woman still stood against the wall. But her hands were together, her lips moved without sound. She was praying.

Mechanically Andrew wrung out his sleeve, pulled on his jacket.

“I’ll fetch my bag later, nurse.”

He went downstairs, through the kitchen into the scullery3. His lips were dry. At the scullery he took a long drink of water. He reached for his hat and coat.

Outside he found Joe standing on the pavement with a tense, expectant face.

“All right, Joe,” he said thickly. “Both all right.”

It was quite light. Nearly five o’clock.

A few miners were already in the streets: the first of the night shift moving out. As Andrew walked with them, spent and slow, his footfalls echoing with the others under the morning sky, he kept thinking blindly, oblivious to all other work he had done in Blaenelly, “I’ve done something; oh, God! I’ve done something real at last.”

3 a room for washing dishes and for similar work

1. “I have done something; oh, God! I’ve done something real at last.” Why does Andrew say this? What does it mean?

2. There lies a great difference between textbook medicine and the world of a practising physician. Discuss.

3. Do you know of any incident when someone has been brought back to life from the brink of death through medical help. Discuss medical procedures such as organ transplant and organ regeneration that are used to save human life.