A Seaside Practise

by Tom Smith

  Mother Gabriel returned. She could see I was troubled, but it was impossible for me, of course, to tell her why. She smiled, and reassured me that everything was for the best. God would look after Dr O’Hara in His own way.

  I don’t know whether or not he did, but the outcome didn’t seem so. Around six months later, I noted a name in the British Medical Journal’s obituary page. Dr Theresa Mary O’Hara had died suddenly from an overwhelming infection in a convent in Ireland. There were no living relatives. I was sad that she hadn’t heeded me. I was visiting the convent the day that the news broke. Mother Gabriel asked me if this had been what I had tried to warn her about. I agreed that it was. ‘It was up to her, not you,’ she said. ‘But she was listening to a different call. Don’t let it bother you.’

  So I didn’t.

  Chapter Four

  Breaking me in

  My baptism of fire in the practice continued the next morning. The phone rang beside the bed at around seven thirty. A man’s voice on the other end of the phone, agitated and breathless: ‘Doctor, you’ll hae to come quick. Maggie’s drappit her mammy in the Muck.’

  It was never thus in Birmingham. I stirred myself and uttered the word for which I would become famous over the next few weeks.

  ‘Pardon?’

  ‘It’s mad Maggie. She’s chucked her mither in the river Muck. The old lady’s sittin’ there, up to her waist, wi’ a’ her kitchen roon aboot her. Maggie’s raging up and doon, yelling at her. It’s at the cottage just below Muck Bridge.’

  I threw on my clothes and looked at the Ordnance survey map pinned to the wall. The river Muck (properly spelt Muick, from the old Scots, but the silent ‘i’ had long been forgotten) was a tributary of the Stinchar. Muck Bridge was on a side road between Braehill and Kilminnel, up in the hills, about six miles away. That wall map was essential to me in those first years. A previous doctor had printed, with meticulous neatness, the names of each family beside the names of each farm and croft. The Muck Bridge cottage bore the name McRobert, so I assumed that the old lady was a McRobert. Maggie I knew nothing of, but the phone conversation suggested that she wasn’t too kindly disposed to her mum. The fact that the anonymous neighbour who had phoned called her, without any malice, ‘mad’, suggested that she already had a reputation for erratic behaviour.

  It took me ten minutes to get to the scene. There was Maggie, a tall, slender, woman, ashen pale with anger, striding up and down the path beside the stream, throwing whatever was left of the kitchen into it. Sitting in the middle was a small, frail, forlorn elderly woman, her tear-stained face a slate-blue colour with the cold. Beside her were two kitchen chairs, a table, a metal bin, and a washboard. Downstream from her, caught up round the stones in the bed of the stream were towels, aprons, tablecloths and even curtains that had been torn down and thrown in by the poor benighted Maggie.

  The younger woman looked up at my car approaching, and saw the police car only a few yards behind it. She flung her last items, an ironing board complete with iron, at her mother, turned and hightailed it up the hill behind the cottage, through the small grove of hazel trees and on to the moorland beyond. In minutes she had disappeared into the mist.

  I wasn’t immediately concerned about Maggie: she could wait. Her mother couldn’t. The policeman and I waded into the water, which was about knee high, and gently carried the old lady into the house. It was wrecked. The stone and earth floor was covered with smashed dishes, cooking pots and old earthenware jars, from some of which a dark, sweet-smelling liquid had spilled. Cinders from the stove had been raked out and thrown around. Some were still glowing. We could see that we had to get the old lady dry, warm and out of there as soon as possible. We didn’t know what that liquid was, but it smelt as if it could be flammable.

  Neighbours soon rallied round, and one was glad to take Mrs McRobert in for a few days while others agreed to put the place to rights. They would make sure the old lady was looked after. But what about Maggie?

  Maggie was in her late thirties, and had been a nurse in a Glasgow teaching hospital. She had had to give up her career to look after her ailing mum, who had become frail and, to be honest, a bit ‘odd’, in the last few years. The alternative to Maggie coming home was for her to go into care, and Maggie hadn’t wanted that. So the career had been put on hold for a while. There were rumours, of course, that this wasn’t the only reason for Maggie’s return home. Neighbours hinted at an affair that had finished, and at Maggie wanting a fresh start.

  The ‘madness’ had been a recent development. People had noticed that Maggie had become a bit irascible lately. She would get angry for no reason when she met old friends at the shop, and was no longer the outward-going, friendly young woman that she had been. She had stopped caring about how she looked: her clothes were dirty and unkempt. She smelled, and she now frightened the local schoolchildren. People put her change of character down to her lost love, or her approaching change of life (naturally a favourite scapegoat for many women’s ills), while she and her mother had gradually become recluses, dependent on one another, getting quietly crazier together, and withdrawing from all contact with friends and neighbours. No one had known that Maggie had been abusing her mother, however, until the episode at the bridge.

  This was an odd story. While the police, assorted neighbours and volunteers started to roam over the hills above the cottage, searching for her, I returned to the Braehill surgery to find Maggie’s notes. To my surprise the folder was thin, almost empty of any encounter between Maggie and the previous doctors. She had never shown a sign of mental illness in the past – which was completely at odds with her behaviour today. I had expected a ‘thick note’ syndrome. Look at any shelf of patients’ notes in a doctor’s surgery and you can instantly tell those who have long-term physical or mental illness. Their folders are far thicker than those around them – regular attendees often need two or three folders taped or banded together to hold all their records.

  Two days later, Maggie was found still alive by the bank of a stream around six miles into the hills. She was cold and wet, but only semi-conscious. I admitted her to the psychiatric unit in Ayr, and she began to recover, physically if not mentally. The consultant psychiatrist, Dr Whitelees, phoned me a few days later. He, too, was puzzled by Maggie’s illness. She was still heavily sedated, so Dr Whitelees hadn’t yet been able to pin down the cause, but he had found that she was very anaemic. He was asking a physician to see her.

  Funnily enough I had asked the same physician to see her mother. She was anaemic, too, and didn’t know who or where she was. She seemed to be living in her childhood, and was constantly talking about going home to her long-dead parents. She had to be restrained from walking out of the house up to the ruin where she had lived as a schoolgirl. How could two women in the same house, with no previous history of mental problems, now be behaving so bizarrely? I’d heard of folie à deux, but this was ridiculous.

  Their blood test results gave us the clue. An alert lab technician spotted that their red cells were mis-shapen and pale, and that there were too many basophils, a particular type of white blood cell, in their blood films. The basophils didn’t look right – they had ‘blobs’ inside them that wouldn’t be there normally. The technical name for the appearance was punctate basophilia, and it meant only one thing.

  I turned my mind back to the scene at the bridge. Mrs McRobert wasn’t slate blue with cold, and Maggie wasn’t pale with anger. They were both grey with lead poisoning. That blood picture, their mad behaviour, and their appearance all fitted with only this diagnosis. We were told the blood biochemistry results minutes later. Maggie’s blood lead level was a record for the lab. Surely her mother’s would be the same.

  I asked the local water board official to meet me at the cottage. The likeliest cause was contaminated water. One of the neighbours was in the living room when we arrived, cleaning up the mess and putting what wa
sn’t broken tidily back on shelves and in cupboards. She had also put sand down on the floor to mop up the dark liquid. It was, she said, Mrs McRobert’s famous bottled fruit and her best guess was that it came from blackberries. Like many people of her age the old lady spent each autumn gathering the fruits of the hedgerows and bottling them. Once the fruit had cooled, she poured the finished product into her glazed earthenware jars, family heirlooms that had come down to her over the years, and sealed them. Bottled fruits, she averred, tasted a lot better when they had been in one of her jars for a while.

  All her neighbours got a present of her fruit every Christmas: they found that just one jar of the bitter-sweet contents was enough. Mrs McRobert, however, swore by their health-giving powers, and ate it regularly throughout the winter. Presumably Maggie did the same. We took a sample for analysis.

  The next step was to test her water supply. We tried to turn on the kitchen tap. It sputtered a few drops of water, then stopped. The neighbour helpfully interrupted.

  ‘Oh you won’t get much out of that tap. They’ve had problems with the mains pressure since the frost two years ago. It’s cracked somewhere, and it hasn’t been fixed yet. We’re so far away from the town, you know. Luckily the McRoberts have the old water tank supply. It’s out there on the hillside.’

  We walked up the hill about fifty yards to where the tank stood, covered with moss, above the house. A pipe led from it to a storage tank in the roof space, and the pipes from that led to the bathroom sink and the sink in the scullery. Only the cold water tap in the kitchen was connected to the mains, and that, it seemed, hadn’t been used for a couple of years.

  You have already guessed it. The tank on the hill, the pipes joining it to the tank in the roof, and the pipes to the other taps were all made of lead.

  We worked it out over the next few days. The two women hadn’t just been drinking lead-filled water; the earthenware glaze lining the pots was also stuffed with lead, and putting fruit inside them was the perfect way to leach it out. The two women couldn’t have conceived a more efficient combination of circumstances by which to poison themselves.

  Happily, lead poisoning is easy to treat. They were admitted, side by side, into a medical ward in the local hospital, and given drugs to draw the lead from their bodies. Within hours they felt better. Within days they were back home, the mains supply restored, and with strict instructions on how best to bottle fruit. The old lady consented to go into a care home, and Maggie went back to work. The ‘mad’ Maggie had gone for ever.

  Chapter Five

  Learning the language and the ropes

  ‘Drapping mammy in the Muck’ was just the beginning. Over the next few weeks I learned a new language, the Scots language that Burns had spoken two hundred years before, and that had hardly changed since he had died. It wasn’t completely foreign to me. Although brought up in England I was born a Scot and familiar enough with the Glasgow dialect of my uncles, aunts and cousins. As the calls came in over the next few days I got quickly up to speed. A few were fairly easy to translate.

  A message that ‘The wean’s come oot in a wheen o’ wee plukes’ was quickly translated into ‘The toddler (the wean) has suddenly developed (come oot in) a very large number of (a wheen o’) small septic spots (wee plukes)’. In other words the child has chickenpox. ‘Rabbie has been boakin’a’nicht’ meant that ‘little Robert has been sick all night’. For ‘I’m fair scunnert wi’ ma man’ read ‘I am heartily sick of my male partner’. ‘Wee Eck has a croachle in his thrapple’ was translated into ‘little Alexander has a rattling noise in his throat’. That was an urgent one, as it suggested that he had croup, and might well choke: wee Eck was dispatched post haste to the children’s hospital in Ayr.

  It seemed that time had stood still, too, in the Collintrae surgery. Dr Rose, my predecessor, had set up in the village in 1933, and had been happy to let the advantages of modern medicines pass him by. Taking my first surgery at his house had been a shock. It was so different from the well-maintained room in Braehill that had been adapted for the purpose by the previous two or three doctors. In Collintrae, a lean-to greenhouse against the side wall of the house served as the waiting room. A wooden bench served as the only seats for the patients: at most, five or six people could wait there at a time. An opening through the house wall led to a small hall, and then the consulting room. The door between the hall and room was thin: everything said above a whisper in the room could be clearly heard in the greenhouse-cum-waiting room. Dr Rose was not one, apparently, for confidential chats.

  Against one wall of the consulting room was a Victorian chaise longue, that had, apparently, served as the examination couch, under which were several tatty cardboard boxes crammed full of files of notes. At the foot of the chaise longue stood three large Winchester bottles. They looked quite impressive: one was full of a milky white liquid, one was green and the third was brown. On a small table at the head of the chaise longue was a tray in which was a bottle with a glass stopper, beside which was a wire frame with a handle, and a pile of muslin swabs. They were all dusty, as if they hadn’t been used for a while – at least since Dr Rose had died. On the other side of the narrow room was a kneehole desk, at which was a comfortable, though well-worn, leather chair, and beside the end of the desk was a wooden chair with a plastic seat that had seen decidedly better days. One was obviously for the comfort of the doctor, the other for the discomfort of the patient. Chairs like this didn’t encourage long conversations.

  On the desk was a copy of the British National Formulary for 1933. It was well-thumbed and very grubby. Many of the pages were dog-eared to make opening them at those pages easier. Several of the prescriptions on those pages were outlined in red ink, suggesting that they were the late doctor’s favourite remedies.

  I looked more closely at the three bottles. The white one was labelled ‘stomach mixture’, the green one ‘tonic’ and the brown one ‘aperient’. I knew the purpose of the bottle with the glass stopper, the wire frame and the swabs, but only from memories of a visit I had made as a small boy with an uncle to the Wellcome Museum of Medicine in Gower Street in London many years before. I opened the stopper and took a very tentative sniff at its contents. It was chloroform: the mask and muslin were used to cover the patient’s nose and mouth while the chloroform was dropped upon it. I could not think why it was in the room, and still apparently used. Chloroform had been abandoned as an anaesthetic in practice long before I had become a student: our generation of students was taught that it had been a good anaesthetic for its time, but its propensity for causing acute fatal liver failure had toned down its popularity a tad.

  The faint aroma of chloroform lingered in the room, so I opened the only window, took a deep breath of the cold April air, and asked my first patient to come in. A pale, frail, thin woman heavily clad in thick winter clothes shuffled in. She looked tired, in fact half-asleep. She was in just to get her repeat prescriptions. I pulled one of the cardboard boxes out from under the chaise longue and looked for the folder with her name on it. It took some time, as Dr Rose appeared to have a poor grasp of the consecutive letters of the alphabet. When I eventually found her notes, I was none the wiser. Dr Rose obviously felt that he knew his patients so well that he could keep all his notes in his head. They were empty. I did find a reference to her appendix removal in 1946, but that was in a letter from the surgeon who had performed the operation.

  ‘Och, it’s a’richt, doctor,’ she reassured me. ‘Ah ken whit Dr Rose gave me. It’s a bottle of the white medicine and half a bottle of the green, and a few sweetie sleepers. Ye’ll fin’ them on that shelf there.’

  On the shelf above the doctor’s desk were the bottles of pills and boxes of creams and inhalers that formed the practice dispensary. By far the largest jar contained thousands of small oblong capsules, green at one end and red at the other, and a rather fetching mixed colour in the middle. I had no idea what they w
ere. There was no label on it. I excused myself for a moment, and went through the door into the main house, to seek Mrs Rose’s help. She was sitting in the kitchen having an early morning coffee and a small glass of a golden liquid about the nature of which I didn’t feel it was my place to enquire. It was nine o’clock in the morning after all.

  ‘Can you tell me what these are?’ I asked her, proffering a few of the ‘sweeties’ in my hand. ‘They are Tuinal,’ she replied. ‘Doctor often gave them to people to help them sleep. They help a lot. I take one or two a night myself.’

  I returned to my patient. I had heard of Tuinal, but I’d never seen them in the flesh, so to speak. It was a mixture of different types of barbiturate. Their makers claimed that they ‘got people to sleep, kept them asleep, and let them wake up fresh each morning’. It certainly did the first two, but I had grave doubts on the third. In fact, Tuinal’s real fame was for helping people not to wake up at all.

  I settled down to have a serious chat with my patient, and for a few seconds thought I was getting somewhere with my lecture on the dangers of barbiturates. I might as well have talked to the wall. Her eyes had become glazed and fixed. It struck me that I was talking to someone who was virtually fast asleep, even though she was sitting on what must have been a most uncomfortable chair. I leaned forward and touched her forearm, lightly. She stirred, and apologised.

  ‘I’m aye drapping aff like this in the mornings,’ she said. ‘I cannae understaun it.’

  I gently suggested it may have something to do with the Tuinal, and added that it might be better for her to take it only on alternative nights for a while, to see if she wakened up a bit. I poured out her stomach medicine and her tonic, and resolved to tackle why she was taking them, too, at another visit.