A Seaside Practise

by Tom Smith

  Jeanie Braidfoot bustled into the room. On a small silver tray was a bottle of whisky, a crystal glass, and a piece of shortbread on a china plate.

  ‘Welcome to Braehill, doctor. I’m thinking you will be needing this,’ she said, smiling. It was only noon, but I took her advice, poured out a small dram, and sipped it.

  That day I learned a lot about Dr Theresa and her month in the practice. She had done the morning surgery, and my plan was to spend my first afternoon in the job going through the current problems in the practice. They weren’t hard to find.

  Dr Theresa had spent most of her time in the convent, virtually in retreat. She had made it plain to the patients that there were times when she should not be disturbed. She had hinted that she was preparing for a ‘better life’ and that they should all do the same. Physical health was not everything: they should be worrying instead about their immortal souls.

  It wasn’t a real surprise, therefore, that when families had needed her most it had been her rosary that she had brought out of her bag, rather than a stethoscope. I suppose in some countries that would have been appropriate. In South Ayrshire, where every village had protestant martyrs’ graves from the days of the religious wars, and where the Church of Scotland ruled, a rosary isn’t the most effective or most acceptable of instruments with which to save a life. It didn’t ease the pain of a heart attack or stem the bleeding from a stomach ulcer, and its appearance in the sick room was calculated to raise the temperature and blood pressure of patients and carers alike.

  Just as bad was her attitude to birth control. She apparently agreed with G. K. Chesterton that it was ‘no birth and no control’. Forthright in refusing the pill or any other form of contraceptive advice to the young women of the practice, she told them it was against God’s law, and she wasn’t having any of it. The pharmacy in Girvan, fourteen miles away, had been doing a roaring trade in Durex in the month in which she had held sway.

  Faced with a groundswell of threats that the patients would sign up with the Girvan doctors, Jeanie Braidfoot held the fort for me. ‘This new young doctor winna be anything like Dr O’Hara,’ she told them, hoping she was right. ‘He’ll soon get us all back on the richt road.’ She must have been persuasive. There were no defections to Girvan so far.

  Fortunately on this my first day there were no urgent calls, and I still had to see the Collintrae end, fourteen miles away, and visit the doctor’s widow there. I thought I would take in a visit to Mr Morgan on the way. I looked through his notes, and saw that he had been retired in the village for around ten years. Before that he had travelled abroad a lot, first in the army, then as a diplomat in various Far East and European countries.

  He lived in a cottage, one of around a dozen stretching along the shore road to the south of the village. I found out later that the polite locals called it pensioners’ row: the others called it death row, as the only way people left them was ‘feet first’. I very quickly learned a lot about local customs in those first few days. For example, the doctor always had to go out by the door he came in. It was very bad luck if he didn’t. I never found out if the bad luck extended to the doctor, or was confined to the family inside. And if people had to leave their house on a stretcher, they had to go head first – never feet first, or they would never return. Feet first was only for coffins.

  The cottages on the shore road had solid storm doors, behind which were less substantial front doors with frosted glass panels. Mr Morgan’s storm door was open, so I rang the bell and waited on the step. After a moment or two I could see movement through the ‘frost’. Even through the glass I could see that the walk was slow and deliberate – a shuffle of short steps, as if very unsure of its foothold.

  When the door opened, a thin old man faced me with a puzzled look on his face. Immediately I felt that there was something wrong with his gaze, but couldn’t quite place what it was. He was a classic ‘elderly shabby’, wearing what once were high-quality clothes – a frayed suit, white shirt with a collar that had seen better days, tie not quite as neat as it should be, with a few food stains down it and the waistcoat.

  ‘What can I do for you?’ he asked, peering at me with those odd eyes, unfettered with glasses, even though he was in his late seventies.

  ‘I’m Dr Smith, your new doctor. I thought I’d call round to check on your boil. I hear that Dr O’Hara lanced it the other day.’

  ‘Boil?’ he replied, as if it were new to him. ‘I don’t know about that. My memory’s not what it used to be. Maybe Mrs Mitchell can help. She looks after me. She’s through the back. Come in.’

  He turned, and as he did so, he almost stumbled. He had to hold on to the wall for a second, to regain his balance. Then he shuffled with those short steps along the passageway into the kitchen, where his housekeeper was washing his dishes.

  It began to dawn on me what might be wrong. The odd eyes, the walk, the memory loss, the boil, they were adding up to something I really didn’t want to consider. By the time he had got to the kitchen, he had already forgotten who I was and what I had come for. But he didn’t seem to care. He sat down as if I weren’t behind him, and stared vacantly out of the window.

  Mrs Mitchell had heard the conversation at the door, and told me not to mind him. He was always forgetting things, but he was harmless. Yes, she had called in Dr O’Hara, because she had seen this boil on his back when she was helping to bathe him the other day. No, it hadn’t been painful, but it did look very nasty, and Dr O’Hara had taken a lot of pus from it. Yes, she had noticed that Dr O’Hara had cut herself while doing it, but she hadn’t bothered much – she had just wrapped a bandage around her finger, and gone off.

  With much foreboding I asked Mrs Mitchell to help show me the boil. Mr Morgan was quite happy for us to manhandle him into position so that we could see his back in the daylight streaming in through the kitchen window. I was becoming less happy by the minute. Between his shoulder blades he had an ulcer – an open sore – with a raised edge all round it. I asked Mrs Mitchell what it had looked like before Dr O’Hara had opened it.

  ‘It was just a raised lump,’ she said. ‘It didn’t look like this. He never complained about it, like he would if it had been a normal boil. I don’t think he even knew it was there.’

  Mr Morgan’s problems were all coming into one diagnosis. We put his shirt back in place, and I walked around in front of him and sat opposite him, across the small kitchen table. I looked again into his eyes and recognised why I had found his gaze so odd. His pupils were of different size, and they weren’t exactly round. The best way to describe them was frayed at the edges, just like his clothes. I shaded them from the light with my hand, then took it away. There was no reaction: they were fixed in that position. They didn’t enlarge with the light or diminish in the shade.

  I was looking at eyes that had been described by a Dr Argyll-Robertson in Victorian times. He had been a specialist in syphilis. The shuffle, the balance problems, the memory loss, and most of all the ‘boil’ – in reality a swelling more correctly called a gumma – all confirmed the diagnosis of the final stage of the disease. I had to get things moving, and fast, not just to get Mr Morgan treatment, but to let Dr O’Hara know just what she had infected herself with.

  My first task was to find Mr Morgan’s next of kin. I had to tell whoever was the nearest relative what I had to do. Mrs Mitchell gave me the name of his son. My day went suddenly from very bad to even worse. For it turned out that I knew the name very well, along with most doctors of my age. He was the Professor of Medicine at a British School of Medicine.

  Suffice it to say that I dialled Professor Morgan’s number and, as expected, got his secretary. She sounded nice and efficient, and very protective of her boss.

  I asked to speak to the great man himself.

  ‘I’m sorry, he is at a lunchtime discussion group at the moment’, she said. ‘I’d rather not dis
turb him at the moment, unless it’s an emergency. Can I help? I do have the professor’s confidence.’

  I’ll bet you have, I thought, but not for the news I’m about to give him.

  ‘It’s actually about his father,’ I said, as coolly as I could. ‘I’m his GP. I think the Professor would want to know about him as soon as possible. It is on the urgent side, and I think I’d better give him the news myself.’

  ‘Oh dear,’ she said, sensing that this was a bit out of the ordinary. ‘Then I’ll get him to the phone.’

  I hung on. The phone was in the hall and I had carefully shut the kitchen door, to be out of earshot of Mrs Mitchell and Mr Morgan. To be frank, I didn’t think Mr Morgan was still sensible enough to grasp anything I said, but I couldn’t risk Mrs Mitchell hearing what I was about to say.

  After a few minutes, the professor’s voice boomed in my ear. Did I know he was busy? Couldn’t his secretary deal with it? He had been brought out of a very important meeting for this call. It had better be worth it.

  ‘Well,’ I started, ‘your father is quite ill, and I think he needs admission.’

  ‘Then send him up to my unit. I’ll take care of him myself,’ was the gruff reply. ‘Send a letter with him, and I’ll take it from there. You can give my secretary your particulars and phone number and I’ll get in touch after I’ve seen him.’

  Unbelievably, he was going to pass the phone back to his secretary. I had to get in fast.

  ‘I think you had better hear the diagnosis first,’ I muttered. As a student I had always felt intimidated by Professors, and this was intimidation in spades.

  ‘Why, what do you think he has?’ came the voice again, a decibel or two above my comfort level. I wondered if the good Professor was deaf as well as domineering. I even started to muse on whether he had been born after his father had contracted his illness. Deafness is, after all, one of the signs of inherited… I put that thought to the back of my mind.

  ‘Tertiary syphilis,’ I said.

  ‘What?’ he bellowed. This time the decibel count was far above earache level. ‘Are you sure?’

  ‘He has a gumma, dementia and Argyll-Robertson pupils,’ I said, hoping that this was enough to convince him.

  ‘Let me phone you back before you do anything further. I need to talk to someone.’ This time the voice was more subdued. There was a click, then the burr of a vacant telephone line. I pondered on what to do next. I needed to find out where Dr O’Hara had gone. I took the chance that someone in the Health Board, who had employed her, might know.

  I drew a blank. Dr O’Hara had left without telling anyone where she had gone, and was no longer available for locum duty. As soon as I put the phone down, it rang. It was the Professor again.

  ‘Please send him in to ward nine in Kilmarnock. Dr Gourlay will look after him there. Oh, and thanks for calling me.’

  Kilmarnock is in north Ayrshire, around fifty miles from Collintrae. It wasn’t too far away, but it was a long way from Professor Morgan’s sphere of influence. I wondered if that was the idea. The boom in the voice had gone: it was still gruff, but low key. I sensed that his thanks were as close to an apology as he could get. He must be worried now about himself, I thought. I wondered how he would organise a syphilis test for himself – just in case he had it too – and then turned to more important matters.

  How could I contact Dr O’Hara? Obviously through the convent. I phoned the nuns to say that I would be on my way to see them. Mother Superior answered, and asked if I could wait until after evening service at around seven o’clock, and I was happy to agree. After seeing the still happy but confused Mr Morgan off in the ambulance to Kilmarnock, I drove into Collintrae village to meet the late doctor’s widow. I was to start surgeries in her house the next morning, and we spent a few minutes sorting out details over a cup of tea, before I went home to see how the three ladies – Bessie, Mairi and Catriona – were getting on.

  Apart from unpacking all the pots and pans, sorting out the crockery that hadn’t been broken on the journey, cleaning all the brick dust from the furniture, unblocking a chimney, fixing a leak from the kitchen sink, preparing a meal, putting down the odd carpet, finding firewood for the fire, and getting rid of several dead mice, they had obviously had an easy few hours. Oddly, I didn’t get any sympathy from them about my tortuous day. When I said that I was going to visit the nuns at seven o’clock, for some reason they didn’t seem too pleased.

  The convent was just a hundred yards from the cottage, so I walked there. There was a half-moon, so I could see fairly well as I ambled along the path, thinking how different the work was from the hustle in Birmingham. I was a little apprehensive, because I hadn’t had any dealings with nuns before, but I needn’t have worried.

  Before it became a convent, it had been a massive, elegant country house, owned by a family that had done well in the Victorian heyday of industrial Scotland. The First World War had seen off their hopes for the future, and the Second World War turned it into a hospital. There was no family left by 1945, so the church took the opportunity to buy the main buildings as a convent school. There were around ninety pupils aged from five to twelve, and thirty nuns. Around them was a large country estate that was now managed by the owner of ‘the big hoose’, the only other mansion house near the village. The nuns had no interest in the estate, so had let it out to their neighbour. That’s why lurching Archie lived next door to us: he looked after the estate for the nuns and the big hoose and lived rent-free in the nuns’ other cottage.

  This much I had gleaned before I made this first visit. Armed with good vibes from Jeanie Braidfoot, who despite her staunch Protestant background said I would love the nuns, I strode up to the large wooden door, lifted the huge brass knocker and let it drop with a resounding clang. It opened slowly, and a tiny female figure, no more than four feet six inches tall, dressed in a black nun’s full-length habit, peered up at me. She had beer-bottle-bottomed glasses on, so I guessed she was virtually blind.

  ‘You’ll be the new doctor,’ she said, with a big beaming smile. ‘You’re very welcome, do come in. Just follow me, and I’ll take you to Mother Superior.’ All I could see ahead of me was a wall of blackness, but I gathered that there was a corridor along which I had to stride after her. Naturally she knew every inch of that corridor and, with her poor eyesight, probably didn’t realise that it was as dark as it was for someone coming out of the moonlit front court.

  That’s why halfway along the corridor I fell over something, to land flat on my face on the wooden floor. My first impression was that I had tripped over a large upholstered stool, but it gave a yelp of pain and moved under my prone body. It took me a second or two to realise that it was the tiny nun. Once over the shock, she started laughing.

  ‘I’m sorry, doctor, we have a wee grotto here in the wall with a wee statue of Mary Mother of Jesus in it. We kneel to it every time we pass, which is why you fell over me. That’s a good start, assaulting the first nun you come across, isn’t it?’ She went into peals of laughter again, and this time fetched a match out of a small purse, lit a taper from beside the statue, and showed me the rest of the way.

  Mother Gabriel, the superior, was brilliant. She met me at the door with a cup of tea, settled me into a comfortable chair in her room, then welcomed me to the district. A charming, educated, very good-looking woman of around fifty, she had laughter lines around her eyes and a great sense of humour.

  I asked if she knew anything about Dr O’Hara and where she had gone.

  ‘A religious maniac that one’, she said. ‘Spent far too much time on her devotions and not enough time having fun. She’s gone to be a nun in Ireland, and I don’t know what the others will make of her. We like a bit of a laugh here, don’t you know. I’ll see if I can find the convent number for you, but I’d be surprised if she’ll want to speak to you.’

  She opened a
small black book on her desk, dialled a number on her phone, then handed it to me, and left the room. I looked around while I was waiting for the answer. There was a wall full of books of all kinds, very few of them religious, many of them scientific. There was even Charles Darwin’s Origin of Species. There were daffodils and crocuses nicely arranged in a small vase, and on the walls were rows of paintings obviously done by the pupils at the school, interspersed with photographs of past pupils and nuns. I liked what I saw, and knew I was going to get on well with them.

  A voice from the phone brought me back to earth. It was the Mother Superior of the other convent. I explained that I was the doctor to the convent in Braehill, and had been given the phone number by Mother Gabriel. The voice at the other end softened. Could I give Mother Gabriel her very kindest best wishes? I promised certainly to do that. And then I asked if I could speak to Dr O’Hara.

  I was told that it wouldn’t be possible. Dr O’Hara had left the outside world and was in retreat. She had left instructions that she could not now communicate with people from her former life. I explained that I thought that she might be ill with a serious infection, and need treatment. I asked if she would please ask Dr O’Hara to come to the phone. I was asked to wait for a few minutes, and then she returned with the message that the infection was healing perfectly well by itself, and Dr O’Hara felt there was nothing more to say. She certainly didn’t want to speak to me about it. After all, I was far less experienced in these things than she was. The phone was put down, and that was the end of the conversation.

  What more could I do? Of course the sore was healing. Primary syphilitic sores always do. But the disease doesn’t vanish. It spreads, and in someone who had received such a big initial dose, it could lead to a fatal infection in months. If she would only take a short course of penicillin she would be fine.