A Seaside Practise

by Tom Smith

  One of us had to go down the slope, through the gap between the trees, over the jagged stumps and torn branches, to reach him. The firemen helped me into the full fireman’s emergency gear of clothing and boots, tied me into a harness and let me down on a rope from a winch on the back of the fire engine. I made slow progress over the slippery ground, over and sometimes through the mess of broken branches and stumps, down to the valley floor. I was sure that I would be examining a corpse: no one could have survived that fall. As I bent over him, the body turned over, and Frank Wilson looked up at me.

  ‘Sorry Doc,’ he said, ‘for getting you out at this time in the morning.’

  Mr Wilson was one of my patients. His family lived in Kilminnel, and he had seen me once or twice for minor ailments. Everyone called hum Lucky Frank because he had some years before won a few pounds on the football pools several weeks in succession. He had certainly been lucky that morning. All he had was a broken left ankle and a few bruises. He had immensely strong arms from years of driving large vans with no power steering. As he tipped over, he had hung on to his steering wheel and braced his spine against the back of his seat. It was only when the cab hit the valley floor and the door burst open, throwing him out, that he had broken his ankle against its metal edge.

  I signalled up to the men at the top, three hundred feet above, to let down a stretcher. By this time the ambulance had arrived, and one of the men came down with it. The three of us were hauled back up to the surface, Lucky Frank on the stretcher, and us beside it, to help steer it away from the wrecked trees.

  This is now where my account gets difficult. My next memory is waking up in a bed, staring at a bare light bulb. As I recall it from forty-five years ago, I tried to close my eyes, but couldn’t. Somehow my eyelids weren’t working. I was lying on my back. My head and face hurt, but I could move my limbs. A hand touched my right arm, and I turned to look at its owner. It was Mairi, sitting beside me, tears streaming down her face. She explained that I had been in an accident, and that I had been unconscious for twelve hours. She was pleased to have me back. She gave me the news that I was shortly to go to theatre to ‘have my eyes fixed’, then a nurse came into the room to wheel me away.

  In the theatre another well-known face bent over me. I was lucky that Professor Jack Mustarde lived in Ayr at the time. He was the most famous plastic surgeon in the west of Scotland, who had trained with Archibald McIndoe in the Second World War, restoring the faces of burnt airmen. He and his registrar, Dr Ghosh, set about stitching what was left of my face together, under local anaesthetic. Jack cheerfully chatted to me throughout, explaining exactly what he and Dr Ghosh were doing, and what had happened to me the day before.

  I’ll draw a veil over my injuries. It’s enough to state that they put over two hundred tiny stitches in my eyelids, forehead and cheeks. I still have the scars to this day but, as Jack said to me, they were designed to look like laughter lines, and my ‘face would grow into them’. He took photographs as he worked, and my ‘before, during and after’ pictures grace one of his textbooks of plastic surgery. I won’t give its title, as they aren’t for the squeamish or even for people with normal sensitivities.

  He told me that as I was preparing to drive home from Glen App a police message had come through from the Bennane Head. A lorry had skidded off the road and hit a man, a Mr Gray, who had just stepped on to the machair from the beach. It was feared that he had serious leg injuries. Could the doctor please attend?

  Perhaps I responded just a little too quickly for the conditions. Perhaps it wasn’t my fault. But on my way down the steep and winding road from Glen App towards Collintrae I turned a corner to face a lorry broadside across the road in front of me. It, too, had met the black ice. I’m told I braked, but the Oxford swept serenely on, straight into the side of the lorry.

  This was before seat belts. I sailed face first over my steering wheel through the windscreen (it was also the days before safety glass), over the bonnet and on to the road. Apparently the lorry driver and his mate rushed to help me as I staggered to my feet, bleeding profusely from my lacerated face. ‘We’ve got to get a doctor,’ one of them said, to which I replied, ‘I am the bloody doctor.’

  My friends will vouch that I never swear. My father, a teacher, had dinned into me from an early age that people who swear must have no command of the English language. So I look upon my outburst as just being a statement of fact. I was certainly bloody and I was the doctor. Enough said. The ambulance carrying Frank from Glen App arrived a few moments later, and I joined him in the back. Apparently he spent the hour and a half it took to get to Ayr helping the crewman look after me, riven with guilt for having brought me to this state of confusion and injury. I remember nothing of this, of course because, as with any severe head injury, I have a permanent loss of memory for the time immediately before it and for many hours afterwards.

  Donald Gray had been taken off by another ambulance, his left leg broken in three places.

  Neither of us stayed long in hospital. It was close to Christmas, and it was decided that I could leave within a week, once the stitches were out and my concussion had recovered enough. It was a sobering time. I have a big head – a hat size of seven and three quarters. I used to take secret pride in the knowledge that I had an exceptionally large brain. My skull X-rays soon put paid to that. They showed that my unusual head circumference was nothing to do with my brain size. Instead, my skull was at least half as thick again than normal skulls. I wasn’t an egg-head but a bone-head – something that I’m sure my friends had suspected for years. On reflection, though, this wasn’t a bad thing. The extra bone thickness meant that it was better able than most skulls to withstand knocks such as being hit by a hard object, viz. one windscreen, at about thirty miles an hour.

  Donald Gray was out of hospital long before me. He had been put into a plaster of Paris bandage that stretched from one hip to his foot, so that he could not bend his hip, his knee or his ankle. He was meant to stay in this hard casing for several weeks, preferably in hospital where he could be looked after properly. As his official address was ‘Number 1, Bennane Cave, Collintrae,’ the social services felt that he would not be returning to a home that was conducive to a good recovery.

  On the first night, however, he had heaved himself out of his bed, wrapped a dressing gown around the nice new nightshirt so thoughtfully provided by the hospital and, while the nursing staff were attending to some other more needy person (it might even have been me), he walked out of the back door of the hospital onto the street. As the hospital was next to the main road to the south, it wasn’t long before a kindly lorry driver, ferry-bound, picked him up, nightshirt, plaster, hospital slippers and all, to deposit him by his cave. All the lorry drivers knew him. Like the villagers, they too left the odd brown paper parcel by the roadside, next to the cave, and they had all heard of his mishap.

  As for me, the local health board found me a locum doctor, who had just retired from a busy practice in Kilmarnock, to take over my duties for the next month or so. Dr Jimmy Anderson turned out to be the silver lining to the cloud of my accident. He became a good friend, he did a massive job for me in looking after the practice, and he decided at the end of his month to move to the district. He became my regular locum for the odd weekend and week away, and continued to do the job for my eventual successor until he was into his late eighties, becoming a very good friend as he did so.

  As for Mr Gray, he kept on his hip plaster until the following May, around four months after its sell-by day was past. He steadfastly refused to go back to the hospital for its removal, and he waved away any attempts by myself or Jimmy to let us remove it. All through the rest of the winter and well into the spring people who passed by the Bennane were regaled with the sight of Mr Gray waddling about with the huge white, then grey, then black plaster from hip to ankle. We marvelled at how fast he could move with it. Eventually I sat down beside him
and suggested that he might let me remove it. This was before we had started to talk. His little grunt gave me hope: I returned to my repaired Morris Oxford and brought out the plaster scissors and knife.

  He kept staring out to sea as I removed the plaster. The leg underneath had healed perfectly. It was strong and healthy, with no sign of any deformity from the three breaks. We threw the plaster on to the fire that burned constantly at the mouth of his cave, and held a silent cremation ceremony around it. Donald looked at me and grunted again. There was even a slight nod of the head that I took for a thank you.

  Four years later, I was called one spring morning to the Bennane Head. This time a van had failed to take a bend at the summit of the hill. The driver of an approaching car had seen it plunge off the road, through the flimsy barrier, over the cliff edge to the sea two hundred feet below. I got there at the same time as Nurse Flora and the ambulance men, the same crew who had helped on that December morning.

  The four of us stood at the broken barrier and looked over the cliff edge at the boiling sea below. I was experiencing déjà vu. There was the splintered wood, with the bakery colours on it, the hundreds of loaves, rolls and cakes littered all the way down the cliff face and floating on the sea. The cab was deep under the sea, about fifteen feet down. We could see the driver’s body lying face down, spreadeagled inches from the shoreline. He was yards away from the sunken cab, so we assumed that he had been thrown out before the cab had hit the sea.

  This time we were sure we were dealing with a death. Flora and I were lowered down to inspect the body. As we approached, it turned over, and Lucky Frank looked up at me. ‘Hi Doc. It’s me again. We’ll have to stop meeting like this,’ he said.

  His only injury was a broken ankle, the other one this time. He told us that he had fallen out of the cab when it bounced against a rocky projection. As luck would have it, he landed on the only hillock of spongy sea grass and moss. A few feet in any direction away from it were either rocks or sea. His ankle had broken, just as it had last time, when it caught against the door frame on the way out.

  Lucky Frank, Flora and I were hauled up by the ambulance team. Frank and the men had a re-union at the top of the cliff, and they took him off to the hospital to sort out his ankle.

  Even though he had wrecked two vans, the bakery didn’t sack him. They did take him off driving duties, however. They promoted him to store manager, a job in which, as far as I know, he had no more disasters.

  Chapter Thirteen

  Children

  To be appointed to a single handed practice back in those days, doctors had to show evidence of experience in children’s medicine – essentially that meant having worked for at least six months as a junior doctor in a children’s hospital. I did my stint in the Birmingham Children’s Hospital, the busiest children’s hospital in Britain outside London. Learning from textbooks and ward rounds as students was all very well, but what we learned as housemen truly fitted us for our role in general practice.

  For example, no textbooks list the condition of LSDCHD. This was a favourite diagnosis of our consultant surgeon, Vincent Burns. He was a massive man with huge hands to match, yet he could use them on the tiniest of babies with unsurpassed skill. It was a privilege to work in theatre with him, but he was at his best for us housemen in the outpatients’ department.

  When I first saw him, in one of his clinics, scrawl LSDCHD across a small boy’s notes I hadn’t a clue what it meant. I was too shy to ask him outright. By the time the session was over, he had made the diagnosis three times, and three small boys went home happily with their mothers, safe in the knowledge that they had nothing to fear from his knife.

  LSDCHD stood for ‘Lady School Doctor’s Cold Hands Disease’. It doesn’t take much imagination to understand why. In those days, school doctors examined every five year old. The boys had to drop their trousers, and the doctors felt to make sure they had two testicles in the right place with no ruptures. One of the lady school doctors must have had poor circulation because, at the touch of her fingers, the boys’ tiny scrota contracted and the testes disappeared like rockets up into their groins. Cold fingers have the added disadvantage of being less sensitive than warm ones, and the tiny testes responded so fast to their touch that the lady assumed that they had never reached their proper position. Children whose testicles had never descended had, of course, to have corrective surgery.

  Hence the constant flow of boys to Vincent Burns’ clinic. Eventually, it is said, he sent the unfortunate doctor a note, plus a small hand warmer, that people use when playing golf in cold weather. From then on, LSDCHD was extinct.

  My main duty in the hospital was as house physician to Dr William Carter, who has been the biggest influence on how I practise medicine. He put kindness and consideration above all else, but was no slouch at diagnosis and, whenever it was possible, treatment. I write that with some sadness, because most of his patients were fatally ill. They either had lethal cancers, mainly leukaemias and brain tumours, or had inherited fatal illnesses that would cut short their lives before they could grow up.

  I spent Christmas in the hospital, at the height of the Beatles mania. Four of us dressed up as the Famous Four, with wigs and dummy guitars and drums, and we travelled round the wards miming to their records. I was Ringo, totally without any sense of rhythm or talent, yet when we reached my ward I got a special cheer from my little bunch of brilliant kids.

  One of the boys in particular stays fresh in my memory. Gregory was the last of three brothers. He was only eleven years old, and he, like the two before him, had a condition called Fanconi’s syndrome. I looked after him during his final few weeks. He was well aware, from his experience with his brothers, that he had no hope. We have learned now, forty years later, that his disease is caused by a single mutation in a gene. Then, all we knew was that he had inherited a condition that stopped his bone marrow from making red blood cells, arrested his growth, gave him a squint and made his kidneys fail. I had had to give him numerous blood transfusions, then tried to make him comfortable as his kidneys finally gave up. There were no kidney dialysis machines for children then, nor were there transplants. Yet Gregory kept his sense of humour to the end. He had a super Christmas day, with presents from all the staff. We Beatles spent an extra ten minutes round his bed, and he was laughing just a little while before he fell asleep for good.

  That day I made the decision not to continue with paediatrics. I knew that I couldn’t face the endless stream of tragedy that I would have to deal with. I needed to find a branch of medicine that would offer happier endings, yet still let me work with children. General practice seemed to be the only one.

  The face of one more child of that time is still very clear to me. He was called Alfie Brownhill, and he was an eight-year-old little imp. Usually a very energetic and well co-ordinated boy, in the two weeks before he had been sent to us he had started to stagger at times, and complained of headaches. At first his mother thought they were migraines, just like the ones she often had, but when they continued, she at last took him to his doctor, who immediately sent him to us. We were a brain tumour ward, and the doctor thought that this was the diagnosis.

  At first we thought the same, but when Alfie himself suggested that the start of the headaches and his difficulty with balance might be linked to a recent fall in the local swimming pool changing room, we changed our minds. He was right. He had hit his head on a tile when falling, and it had cracked a bone in his temple. The sharp surface of the fracture had torn a blood vessel underneath, and blood oozing from it had formed a clot on the surface of his brain, the medical name for which is subdural haematoma. This had led to pressure on his brain, which had caused his symptoms. We were thrilled to find that clot, because it meant we could do something to cure his problems – something of a rarity on the ward. The surgery was successful, the clot was removed, and he became a normal little boy again.

 
; Good as his story is, it isn’t the reason I remember him. No, my sharpest memory of Alfie is of the day he was presented as a ‘case study’ to the rest of the hospital medical staff. Once a week all our teams of doctors, students and nurses met to hear presentations of unusual ‘cases’. Alfie, having been both a medical and surgical patient, was going to be shown to us by the medical registrar, Jane Fulton, my senior by two years. She first said a few sentences about the investigation of headaches and balance problems, then asked my opposite number on the surgical ward, Manu Tailor, to show Alfie to the audience.

  As Manu wheeled Alfie, in pyjamas, dressing gown and part-shaven head, on to the stage, Dr Fulton started her talk.

  ‘This is case number 63-52’, she said. ‘To summarise first. Three weeks ago he hit his head against a tile floor, and sustained a skull fracture and a subdural haematoma. I am going to demonstrate the physical signs and the intellectual deficit that he has incurred.’

  ‘Oh, no, you are not,’ came a small voice from the stage. ‘I’m not a number. My name’s Alfie Brownhill, and I’m a boy. And I’m not knocked stupid, either. I know what intellectual deficit means.’