A Seaside Practise

by Tom Smith

  One of the officers apologised for bringing him in. They had found him slumped on a bench in a nearby park. They had thought he was drunk, but he was complaining about a stomach pain, and they felt they had better bring him to me before taking him in for a night in the cells, where they could at least give him food and warmth. The police, incidentally, were like that wherever I have worked, in Birmingham or Ayrshire. Their main aim was to help this man, not to bully him or charge him.

  The man himself looked around fifty years old, though he could have been thirty. Homeless people, like prime ministers, age faster than the rest of us. They probably have similar levels of stress. He was filthy, hadn’t washed or shaved for weeks, and had obviously starved for several days. His cheeks were sunken and flushed, he was breathing heavily, and didn’t smell, even faintly, of drink. He was pleased to see me, again an unusual reaction in a down-and-out.

  Down and out he certainly was. One of the policemen helped me to undress him. He was in a lot of pain, and his stomach was as stiff as a board. As I felt his abdomen, he winced, and the muscles below my fingers tensed into a hard solid sheet. His pulse was fast and thready and his blood pressure low.

  It took seconds for me to recognise that he had peritonitis, either from a ruptured appendix or from a perforated stomach ulcer. My only option was to get him straight to hospital from the surgery. There was a blanket on a chair near the couch, so I asked one of the officers to make him comfortable by wrapping it around him, while I reached for the phone.

  Within a quarter of an hour, he was on his way by ambulance. I thanked the policemen, and looked at the time. The surgery had taken from five-thirty until nine o’clock. I phoned home, to apologise for being so late, and left the surgery with the blanket folded on the couch. Mairi was used to my late arrival in the evenings, and wasn’t upset. I don’t know how she did it, but there was always hot food ready whenever I arrived after surgery, along with a small whisky and water. There were times when I was so tired that all I wanted was the drink.

  After supper, we sat together to study the practice agreement. It was full of the usual restrictions prevalent at the time. If I were to leave the partnership, I could not practise within the surrounding fifteen miles. That was to stop me ‘poaching’ patients from them. It would take ten years for my pay to achieve ‘parity’ with that of the other partners, but the work would be equally shared amongst us. Except that the senior partner would take three fewer surgeries per week, to manage the finances and organise the practice and the buildings. The senior partner would not have to do evening surgeries more than once a week, and would have two weekends off per month. That was apparently because he was older and had spent many years building up the patient numbers, and deserved a little extra. The clauses about us paying part of the gardeners’ and cleaner’s wages were included. It was also interesting that although I was to be paid a lot less than the others over these future ten years, I was expected to pay a full third of the practice expenses. So the proportion of my income taken off for all these expenses was much greater than for the other two partners.

  The proposed agreement was so unfair that we began to laugh. Not in a million years were we going to stay. But the biggest laugh was in the final paragraph. It ran something like this:

  ‘If the sons of the senior partner and of any subsequent partners qualify in medicine and wish to join the practice, then the senior partner’s son will have seniority’.

  I had an extra whisky on the basis of that one. The next day, we decided, we would look for a practice in Scotland. Preferably one without partners and, of course, near the sea.

  The third thing that sent me packing happened first thing the next morning, and made my mind up once and for all. Just before setting out for the morning surgery, a man came to the door carrying a large brown paper parcel. A label on it stated it was for ‘Dr Smith’s Wife’. Mairi was excited. The outside label didn’t list the sender, but it was obviously a gift of some sort, perhaps from someone who knew that she was expecting our first baby. This was the first sign of thanks from anyone in the practice in the three months we had been there.

  Just as pleased, I stayed behind for a few minutes to see what it was. It was the blanket the tramp had been wrapped in the evening before. Miriam had sent a note with it. There were no pleasantries such as ‘Dear Mairi’. I remember the exact words today, forty years on. They were in capital letters, perhaps to indicate the writer’s anger.

  YOUR HUSBAND HAS ALLOWED THIS BLANKET TO BECOME INFESTED WITH FLEAS. I HAVE NO INTENTION OF LAUNDERING IT MYSELF. WE NEED IT CLEAN AND UNINFESTED FOR NEXT MONDAY MORNING SURGERY

  There was not even a signature, or ‘kind regards’, although I suppose kind regards would be hypocritical under the circumstances. Luckily Mairi has a sense of humour: she just laughed it off. I, by this stage, was beyond incandescent.

  The blanket was laundered and delivered on time. I didn’t ever have a conversation with Miriam again, nor did I sign the agreement. I still spoke to Dai, who was strangely subdued with me. I suspect he was deeply ashamed of his wife’s behaviour, but neither of us broached the subject. He wasn’t surprised when I didn’t sign and return the proposed agreement.

  He did, however, try to remonstrate with me about sick notes. Apparently he had been wakened at seven-thirty that morning by about a dozen men wanting sick notes to go back to their morning shift work that day. They couldn’t wait until the surgery opened at nine a.m., because by then the shift would have started, and they would have lost half their week’s wages. They had accused me of ‘not co-operating’ and being an ‘examining’ doctor when all they wanted was their usual note. I looked at him, sitting comfortably in his big leather consulting armchair. In his mid-fifties, he had long since stopped wanting to rock the boat. The income from work notes was a good extra for the practice, from which he stressed I would assuredly receive my share. If I didn’t toe the line with them, we would lose a lot of patients to the McKelvie practice down the road. After all, they were doing the same thing, so that wouldn’t do, would it?

  I wish I could write here that I stood on a matter of principle and argued the toss with him, but I didn’t. Instead I came to a compromise.

  ‘If you like,’ I said, ‘I’ll do regular Friday evening surgeries instead of the Thursday ones. Then you can collect all the work note money and you won’t need to share it with me – you and Owen can keep it all to yourselves.’

  Amazingly the insult implied in the last suggestion washed over him. He was delighted by both propositions, and we stuck to them until I left. I didn’t bother, either, arguing about the salary. I put it down to experience and accepted the loss.

  I didn’t take long to leave. Mairi found the advert and we applied for it. At the interview it turned out that there were two adjoining practices – Braehill and Collintrae – that were both currently without doctors. The Braehill doctor had left to join a city practice, and the Collintrae doctor had left for the great surgery in the sky. My interviewers asked me if I would consider combining them, and I responded with the enthusiasm of the young, keen and wholly inexperienced. The other interviewees were clearly older and wiser doctors looking for an easier time, for I was given the job.

  Chapter Three

  Getting There

  The Collintrae practice, with its location on the shores of the Firth of Clyde, had won Mairi over before we had even arrived. Our journey there, however, was enough to dampen even the brightest of spirits. Mairi had only just given birth to our first child, Catriona, when we left the practice in Birmingham. An uncle of mine had a friend with a haulage business whose lorries often travelled loaded from Scotland to the Midlands and empty back again, so he offered help with the move. We would only have to pay about a tenth of the usual removal rate – to cover the fuel for the extra hundred miles of detour the driver would have to make on his return to Glasgow - for which we were extremely gratef
ul. What we didn’t expect was a brick lorry to turn up at our door. Granted there were no bricks on it, but the dust was there, and there were no sides. Our precious few possessions were to be hauled on a flat-back and covered with a tarpaulin. It was up to us, too, to load it. The driver was on his own, and naturally couldn’t shift the furniture by himself.

  Mairi, game as she was, was hardly in a fit state to help. She had had a long and exhausting labour, and was breast feeding. With no parents around us to help with the baby (we were both the single children of older parents, who lived hundreds of miles away), she had still to function as a doctor’s wife, as I worked out my final few weeks of partnership. Drs Dai and Owen extracted the full working time from me – there was no thought of paternity leave then. So I had to do my last surgery, then come back early to help load the lorry.

  Somehow the driver and I managed to heave our things aboard, spread the tarpaulin over them and tie it down. We gave the driver directions and watched everything we owned vanish into the March fog. It crossed my mind that I might never see it again, but I put the thought aside. Mairi, Catriona and I climbed aboard our Morris 1100 and set off for the north.

  It sounds simple, doesn’t it. A happy little family heading homewards. We planned to take the eight-hour journey to Ayr, where Mairi’s mother lived, in easy stages. We would stay there overnight, then drive down to Collintrae to meet our lorry at the gates of our new home.

  We didn’t bargain for two complications. The first was nappies. Mairi had been told of these miraculous new watertight disposable nappies for travellers. We could change the baby at strategic points en route, and leave all smells behind us. Fat chance. Whoever had made the claims about those nappies was deceiving the public. Within minutes, we seemed to have, for the want of a better word, breast-fed baby poo all over the inside of the car. The smell developed nicely as we travelled along, so that the air around us became unbreathable. We had the choice of the windows open and freezing to death (it was March) or windows closed and suffocating.

  On top of that I had a dose of the runs. In the practice over the previous few days we had seen dozens of cases of diarrhoea and vomiting. We used to call it ‘gastric ‘flu’. Today we would glorify the infection by calling it an outbreak of Norwalk virus, or norovirus. By any name it smells as sweet. I had picked precisely the day of the removal to start my dose of it.

  So with aching gut, having to stop every few miles – at every second pub or café – to deal with both my problems and Catriona’s, we made slow and fitful progress up the map of Britain. We passed all those towns starting with W – Wolverhampton, Walsall, Warrington, Wigan – watching beside us the new motorway grow out of what appeared to be industrial desolation. The roadworks every few miles as ‘heavy plant’ crossed the old A6 to the embryonic M-way held us up further. My gut didn’t take too well to the long periods of standstill.

  I’ll draw a veil over the rest of that day. It’s enough to state that we arrived in Ayr a full five hours later than planned. I had left most of my body weight in various conveniences on the way. The only one of us who took the journey in her stride was baby Catriona, who fed, slept and defaecated happily throughout. Mairi’s widowed mum Bessie, delighted to see us, ushered us into the dining room. She had prepared a feast for us. I excused myself and threw up, for the twentieth time that day.

  It wasn’t an auspicious start. The next morning we drove the forty miles to Braehill. The previous doctor’s house in Collintrae wasn’t yet available to us – his widow still occupied it. The last doctor in Braehill had lodged in the village, having used the practice as a temporary stepping stone to a better and bigger practice, and the room he had rented wasn’t suitable for us either. So the kindly sisters at the convent in Braehill had offered us a cottage of theirs for the time being. We had a map, and we were to meet our brick lorry outside the cottage at around ten. Bessie came along with us. She couldn’t help much physically, as she was frail, but she offered much-needed moral support and another pair of hands to hold the baby.

  Still dehydrated, nauseated and with an aching gut, I finally drove up to our new home. Well, almost. The nuns, from whom we were renting our new home, hadn’t told us that there was a rustic bridge just in front of the cottage, with a large sign beside it: ‘Not suitable for vehicles of 5 tons or over’. No way was our brick lorry able to cross over, and the driver had stopped just short of it, blocking the way. He looked at us as if we were crazy. He couldn’t believe that we had moved from the sophisticated city to this hovel in the boondocks.

  Luckily we had new neighbours. Out from the door of the adjoining cottage lurched Archie McLaren. We found out in the days to come that Archie always lurched. It was a combination of his continual intake of raw whisky and his work as a gamekeeper: his feet had constantly to deal with walking on uneven ground in the total absence of sensible messages from his sozzled brain about where they actually were in space. But Archie’s heart was in the right place. He brought his tractor out from the shed behind our two cottages, and in a few trips across the bridge he had unloaded the lorry and emptied the contents into our new home.

  Mairi and her mother started to sort out our goods and chattels, while I drove to the surgery to meet the outgoing doctor. She would pass on to me the details of patients she had been seeing, and I could pass on to her a cheque for the month’s locum fee that I owed her.

  That month had been critical. Single-handed rural doctors were appointed by the local authority health committee. After an interview conducted by local councillors and the odd (in fact, very odd) doctor, I had been offered the job to start on March 1st. My Birmingham partners had kept me to a three-month notice period, which meant that the first day I could start was April 1st. From the previous Braehill doctor’s departure, and from the Collintrae doctor’s death a week later, until March 1st, a retired GP living in the area had volunteered to run the two practices, but from then onwards I was held to be responsible for them. The retired man had other commitments, so I had to find a locum to take my place for that month.

  Of course, being in Birmingham, I had no way of choosing my locum, so the local medical committee found one for me. Hence this meeting with Dr Theresa Mary O’Hara at Braehill that morning. Dr O’Hara, a fifty-ish, feisty and single Irish woman, hadn’t taken up the previous doctor’s widow’s offer of a room at her house in Collintrae. Instead, she had taken a room, in fact what was little more than a cell, at the convent, where the nuns were initially delighted to have the doctor in residence for the month. She had worked from there, being on call from the convent, which the patients, Presbyterian to a man and woman, found curious.

  Dr Theresa was keen to get going. Most accents from the southern counties of Ireland are like music to my ears. I enjoy the softness and the rhythm, and usually warm to them. It wasn’t like that with Dr Theresa. She was a small, thin, bird-like woman, and her voice was sharp and harsh, the words coming like machine-gun bullets, clipped at the edges. She was constantly fidgeting and twitching, crossing and uncrossing her legs, which were discreetly hidden under a long black skirt. She wore black sandals over thick woollen stockings. Her upper body was hidden in a rough grey sweater over which lay a plain metal chain necklace from the centre of which hung a large crucifix. I wondered, vaguely, what she did with it when bending over a patient. Did she sling it over a shoulder, to get it out of the way? I thought of gynaecologists I knew who wore bow ties, so that they wouldn’t get in the way, but put the thought out of my mind as sacrilegious. .

  She rattled through the histories of cases she had seen in the month. I couldn’t follow her in detail. My gut was still aching, the nausea hadn’t completely gone, and I was half-asleep from our marathon of the day before. So my mind started drifting. As her voice faded into the background, my eyes wandered, stopping at a narrow bandage over the middle third of her left index finger. She was repeatedly rubbing and plucking at it, as if it were bothering
her. The finger above the bandage was swollen and inflamed, and the redness was stretching towards the back of her hand.

  She paused to sip her tea. I took the chance to ask about her finger.

  ‘Have you hurt your finger?’ I asked.

  She looked down at it, then back at me. ‘It’s nothing. I cut myself opening a boil. It is a little infected, but it is healing now.’

  It didn’t look as if it were healing to me. I asked if she had taken an antibiotic for it, and whether she would like me to take a swab and send it to the lab.

  ‘You never know,’ I said, ‘you may have a fairly virulent bacterium there. There are plenty of antibiotics here, so you could start on one now, and I could send you the lab results later. Let me have your forwarding address, and we’ll keep in touch.’

  Dr Theresa drew herself up in her seat, stiff, erect and face flushed with anger. Although around ten inches shorter than me, somehow she towered over me.

  ‘Young man,’ she said, ‘you are thirty years my junior. I won’t take advice on how to treat a simple cut from you. And I’m certainly not taking an antibiotic. This will heal in its own time. Now if you don’t mind, I’ll take my cheque and leave. You will not be needing a forwarding address.’

  ‘At least let me know whose boil you lanced, so I can check that that has healed, too,’ I replied. I wasn’t going to let her browbeat me, and there was something about that finger that disturbed me.

  ‘If you must know, it was a man called Peter Morgan, an elderly gentleman in Collintrae. You’ll find his address in the notes. Now if you don’t mind…’ Her voice drifted away. She took the cheque from me, rubbed her finger again, and walked out of my life and the lives of the people she had tended for the past four weeks.