A Seaside Practise

by Tom Smith

  ‘It wasn’t the figures, Doc. It was him. Dr Hall.’

  ‘Pardon?’

  ‘He didn’t know me, but I knew him,’ Steven said. ‘We’re members of the same club – the RAC club in Glasgow. I’ve seen him sitting over his brandies there, in a corner, and his chauffeur waiting for him outside in the car. You know why he has a chauffeur? He’s banned from driving. He’s a lush. When he bent over me, I could smell the booze on his breath. I suddenly thought – is this what I’ll be like? I decided I didn’t want that, so I’m stopping.’

  Sadly, Dr Hall didn’t fare so well. A year later he died. His obituaries in the press, national and medical, referred to the great contributions he had made to gastroenterology, to his special interest in alcoholic liver disease and to his ‘larger than life’ or ‘jovial’ or ‘clubbable’ personality.

  Chapter Sixteen

  Did she or didn’t she?

  Elsie Turner was in her mid-thirties when I first got to know her. Tall, slim, with brown eyes matching her hair, and the even features of a model, she had the sort of looks that made both women and men stop, just for an instant, when she entered a room. She was the beauty of the district, and she made sure everyone knew it. At the parish meetings, the Women’s Guild, and the Conservative party coffee mornings she was always the star. At church on Sundays, she was the last to enter, her high heels taking her elegantly past the rest of the congregation to her reserved pew at the front. She made a point of settling into her place just before the entrance of the minister. She was there most definitely to be seen.

  Elsie was the last of her line, but it was not a Collintrae line. She had known the village all her life, the only daughter of parents who had had a holiday house there from before she was even born. She could well have been conceived there, but that didn’t make her or her family natives. The Turners remained ‘incomers’ even after, when Mr Turner retired, they had sold their Edinburgh home to move permanently to Collintrae.

  Mr Turner had been someone in the City (which in Scotland, of course, means Edinburgh), and had spared no expense in improving, extending, decorating and furnishing his Collintrae house over the years until it was the most luxurious house in the village.

  Or so rumour had it. Unfortunately, few people had the chance to confirm whether this was so. Its glamorous reputation remained hearsay. The older Turners were not gregarious, and held no soirées or dinner parties. If they were intending to hold them, their plans were cut short when Mr Turner died suddenly only a month into his too-short retirement. From then on, Elsie, now in her mid-twenties, had had to look after her mother, Catherine.

  By the time I arrived in the village, ten years after Mr Turner’s death, Catherine was in great physical difficulties. A small, very thin, frail woman, she had had a severe form of arthritis for years that had affected her spine, hips and knees, so that she could only shuffle around the house. With a stick in each hand to take the weight from her legs, she moved one foot in front of her about six inches, then painfully dragged the other next to it. She had to repeat this dozens of times to go from the dining room to the kitchen, and again to the bathroom, the living room and her bedroom, all of which were on the ground floor. Her neck vertebrae had fused into a solid mass, so that her head was rigidly set and could not swivel on her shoulders. To see to either side she had to turn her whole body, a very difficult manoeuvre while she was standing and impossible when seated.

  To make matters worse, the lack of movement in her joints and under-use of her muscles had made her bones very brittle. Two years before she had broken a wrist simply by putting too much weight on it when rising from a chair, and any slip or fall would surely result in a more serious fracture, perhaps of a hip. She did the best she could, but needed all the help she could get to attend to her smallest needs. It meant that Elsie was fully occupied with her from morning to night. Elsie’s haven was a small sitting room and bedroom upstairs, to which she would escape whenever she could, usually only when her mother was asleep. Even then she was at the call of a bell that her mother would ring when she needed her.

  Nurse Flora came in to give a hand as often as her busy schedule permitted, but it was only a fraction of the burden that fell on Elsie’s shoulders. I asked Catherine one day why she didn’t employ a woman from the village to help her, and to give Elsie a break, but she didn’t see the need. Elsie was all that she needed: she was family, and she didn’t want anyone from the village in the house – apart, of course, from nurse, doctor and minister.

  I visited the Turner house every week, more often if the old lady was in pain and needed injections, but was frustrated by being unable to organise more help, mainly to give Elsie a rest, rather than to please Catherine. It wasn’t long before I realised there was an undercurrent of anger simmering between them. The younger woman resented that she had no permissible social life because of her total commitment to her mother’s health. The older woman, although outwardly kind and generous (she was the biggest donor to church funds and to all the local charities), was blind to the fact that her daughter was growing older and sacrificing the chance of a life of her own. For her the prime function of a daughter was to look after her parent: there could be no argument about that. She made sure, from time to time, in blazing rows, that Elsie understood.

  So life had gone on for the two women, the younger one becoming more frustrated and the older one more ill and incapacitated as the years passed. That, and their discovery that Mr Turner had left them with much less money than they expected, made it difficult to entertain friends. They were isolated from the society that they had been used to in Edinburgh and, still clinging to the Edwardian ideas of social class, had never brought themselves down to the level of making close friends of the villagers. It was one thing to mix with them at charity or church functions, in fact it was their duty to do so, but quite another to invite them home.

  There were rumours, however, that Elsie was not the slave to her mother that she appeared. It was said that she was living a double life, and that she had ‘friends’ whom she would meet late in the evenings. The house was built on a slope so that at the back there was a short outside staircase leading directly to the first floor, and Elsie’s self-contained flat. Behind the house there was a convenient wooded area, through which anyone walking late at night could reach the staircase without the need to pass by the front door. Anyone could walk through the woods, and a surprising number of men had dogs to exercise in the evenings.

  The village wives, naturally, were suspicious of her, and their worries were reinforced by memories of Elsie’s conquests at village dances in her younger days. She had been known as a flirt and a tease, and there were darker mutterings that she did more than tease.

  Of course none of this reached my ears: no one carried gossip to the doctor or the doctor’s wife. We, too, were incomers, and not privy to the village gossip, but much of the distance between us and the villagers was of our own making. It’s best not to become too friendly with your patients in a single-handed practice. There always comes a time when the doctor has to make a serious decision for a patient, and it’s crucial that friendship or an emotional attachment does not interfere with clinical judgment. A plea from a friend in a crisis not to send him into hospital is more difficult to resist than a plea from a patient who is socially a stranger. It’s best for doctors to find their closest friends among people outside their practice. A result of this is, of course, that they miss a lot of what is going on in a village, and thus it was that the growing problems in the Turner house escaped me.

  Twice a year Mairi and I and the two children took a fortnight’s holiday. We had to book a locum doctor for those two weeks, because we felt it wrong to ask Dr Jimmy to stand in for so long. He was an excellent stand-in for a day or two at a time, but he was over sixty five and a two-week stretch without a break was an unfair burden on him. So we advertised in one of the medical papers, and were deli
ghted with the response from a host of young doctors willing to take on the country practice as a break from busy hospitals or city practices. On this occasion we chose the one who seemed the most experienced and enthusiastic, and looked forward to him arriving.

  The day before we left, I visited the Turners. I wanted to make sure that Mrs Turner had all the drugs she needed for the month ahead, and to tell them about the locum. It was a warm summer’s day, and the windows on the ground floor were open. As I walked up the drive to the front door I could hear, through one of the windows, voices raised in anger. Yet when Elsie opened the door to me, all was sweetness and light. The two women welcomed me, Catherine seated in her usual armchair, Elsie perched on one arm, as if they had never had a cross word. I talked to them for a while, gave Elsie the pack of medicines, reassured them on the quality of the new doctor, checked on Catherine’s pulse and blood pressure and left.

  On our return from holiday my locum was waiting for me. He had a list of patients he had seen, and had certainly kept up a high standard of practice. There had only been one death, he said – a Mrs Catherine Turner.

  This was a surprise. She was frail, but there was nothing to predict an impending sudden death.

  ‘What happened?’ I asked. ‘Did she have a heart attack or a stroke? Her blood pressure and pulse were OK when I last saw her.’

  ‘No, it was just an unfortunate accident,’ he replied. ‘She fell downstairs. Her daughter found her in the morning, just two days after you left. She was in a crumpled heap at the bottom of the stairs. Her neck was broken. She had such advanced osteoporosis I suppose any fall might have caused that – especially if it was down a staircase.’

  I couldn’t believe what I was hearing.

  ‘But she couldn’t have been on a stair. She couldn’t lift either foot more than an inch off the floor. She would never have attempted to go upstairs. Did you report the sudden death?’

  ‘Sure,’ he replied. ‘I phoned the Procurator Fiscal and gave him all the details. I had your notes to say that she had advanced osteoporosis, and that you had seen her just two days before. He asked if I thought there could be any cause for suspicion of anything more than an accident, and I didn’t. So he allowed me to sign the death certificate and the cremation forms.’

  ‘The cremation forms?’ I asked. ‘But everyone gets buried here. The cemetery is just outside the village: the nearest crematorium is in Ayr, forty miles away. Who asked for cremation?’

  ‘Her daughter, Elsie. She said that the family had always been for cremation, rather than burial, and that was her mother’s wish.’

  ‘Who signed the second part?’ I asked. ‘Was it Jimmy Anderson?’

  ‘No, Jimmy was away for a few days. I got one of the Stranraer doctors to do it. He’s an old friend. He came to see the body, and agreed that the injuries were compatible with an accident. Why are you asking all these questions? You don’t think Elsie could have had something to do with her death, surely?’

  ‘I’m not sure,’ I said. ‘But if she has been cremated, we can’t do anything about another opinion now. If she killed her mother, she has got away with it.’

  My locum was shocked. ‘I’m sorry,’ he said. ‘I just didn’t think there could be anything abnormal about this death. Her daughter seemed perfectly nice, and so fond of her mother. I find it hard to believe that she might have done anything to harm her’.

  ‘Then maybe you should have a conversation with her father about it,’ I said.

  ‘What do you mean?’ he asked. ‘Didn’t he die ten years ago?’

  ‘Yes,’ I replied. ‘He is lying in the Collintrae graveyard, just a mile away. His widow buried him. Curious, isn’t it, that she didn’t want to lie beside him?’

  Could Elsie be harbouring a very disturbed personality behind her charming façade? I resolved to be very careful in my dealings with her from then on.

  The death of her mother let her spread her wings more widely, and she began to live a little. There’s an old story about the minister who had lost his bicycle. Convinced it had been stolen by one of his flock, he asked the parish clerk how he might retrieve it without involving the police. The clerk suggested that he preach a sermon on the Ten Commandments, and that when he got to ‘thou shalt not steal’ he should pause for a moment and scan the faces of the faithful. The guilty one among them would not fail to blush and so give himself away. On the following Sunday the clerk was surprised to hear the minister rattling through the Ten Commandments without stopping. Curious about this, he asked the minister afterwards why he had not paused at the appropriate commandment. It was simple, said the minister. When he got to ‘thou shalt not commit adultery’, he remembered where he had left his bike.

  Apparently there were bicycles aplenty – needless to say, not the minister’s - to be seen from time to time leaning against Elsie’s back door. She was shameless in making up for her wasted years. After a few months, the bicycles became fewer, and one car in particular started to grace her drive.

  Its owner lived a few miles away, near Braehill, in a substantial estate house. Angus Marshall was an early retiree from the city, who had known the Turners when they lived in Edinburgh. Twenty years older than Elsie, and fifteen years younger than her parents, he had been like an older brother or a relatively young uncle to her – or so she told me, one day as I was renewing her prescription. Since her mother’s death, she had had to have the contraceptive pill, not for contraceptive purposes of course, but to ‘regulate her periods’. She was entering that certain age for women, she said, and wanted to make certain that it went smoothly.

  Mr Marshall was helping her out with her financial problems, she said, which was why his car was so often in front of her house. Why she had to tell me this I wasn’t sure. It struck me as unnecessary, and perhaps a small sign that she was feeling guilty about something.

  The Marshalls were also patients of mine. He was fit and physically active, being part of a syndicate of farmers and estate owners, who reared and shot pheasants and grouse on the hillside behind his home. He also owned a stretch of Cree water on which to indulge his passion for salmon and sea trout fishing. The Cree runs south from the hills around Braehill through Newton Stewart to the Solway. It is the neighbouring river to the Stinchar, and the locals argue interminably without ever reaching a conclusion about their relative merits.

  However, Angus Marshall’s main activity was to look after his sick wife. Olive Marshall suffered from what was then called ‘pre-senile dementia’ and is now better known as Alzheimer’s disease. By the time I took over her care – I visited her once a month, and Nurse Flora dropped in once a week - the disease was in its middle stages. She was careless about her looks, found it difficult to remember things, was neglecting the housework and cooking and had given up almost all of her social activities. Friends did visit, but were calling less and less often because she had so little to say, and was too confused to recognise them or appreciate their company. Angus organised for a woman to stay with her several times a week, so that he could have some freedom. Visiting Elsie was one of these ‘freedoms’.

  A year after her mother died, I was due my next summer holiday, and had yet again to employ a doctor to stand in. My locum of the previous year was now in a practice of his own, and was unavailable, so I had to advertise again. This time a young woman was the most suitable, and both Mairi and I were thrilled when she accepted the job.

  In the usual way, I discussed with her the care of the various people she would have to visit, one of whom was Olive Marshall. She said she would be delighted to look in on her, and I left for our holiday in Cornwall happy that the practice was in safe hands.

  On my return, she told me that there had been one death while I was away – Olive Marshall. This time I wasn’t too surprised, because dementia often takes people suddenly, when one isn’t really expecting it. What did surprise me was how
the death had happened.

  Apparently, Olive had gone missing the evening after my departure on holiday. She had walked out of the door late in the evening when the lady looking after her had been preparing her bath, and had had her attention diverted by a phone call. After a frantic search, Olive had been found next morning face-down in the small stream beside the house. Like so many other streams running off the hillside, it had carved out a steep mini-ravine for itself, and anyone falling over the edge would hit the rocks a good ten feet below. In her precarious state she had no chance of surviving. Her skull was fractured, and there were clear marks down the side of the bank where she had obviously fallen. She was in her nightshirt and slippers, corroborating the story of the lady looking after her.

  ‘Who was this lady?’ I asked.

  ‘A Miss Turner’ was the reply.

  ‘Elsie Turner?’ I asked. ‘Was she upset?’

  ‘Very. She needed sedation after the body was found. She kept on blaming herself. She said she had searched all night, but hadn’t been able to see down into the stream.’

  ‘Where was Mr Marshall at the time?’ I asked.

  ‘He had gone to Glasgow to meet up with friends. Apparently Miss Turner had suggested he needed a night away, and offered to look after his wife. She was devastated that this had happened.’

  I’ll bet she was, I thought. How convenient that on the two occasions when the resident doctor was away there had been two accidental deaths that impinged so directly on her life. Did she think that I would have taken things much further than a locum might?

  ‘Did you inform the Procurator Fiscal?’ I asked.

  ‘There was no need,’ she said. ‘There were police everywhere the next day, first hunting for her and then, after she was found, looking for evidence of foul play.’