A Seaside Practise

by Tom Smith

  ‘And was there any?’

  ‘No. There had been a lot of footprints in the grass just above where she fell into the stream, but they were explained. Apparently Miss Turner had been walking there the previous evening looking for her, with no success.’

  ‘So it was put down as an accidental death?’

  ‘Yes.’

  Once my locum had gone, I telephoned the Procurator Fiscal’s office. He had taken his holiday at the same time as I had, and a locum Fiscal had been in place when the accident had been investigated. No one had made any connection between the two deaths, and there was still no reason to connect them. The consensus was that they were just a sad coincidence for Miss Turner, and there was little point in stirring things further.

  I thought about it for a while, then let it drop. Nothing I could do would bring the two women back, and any interference from me would only raise unpleasant, unprovable suspicions. Reluctantly, I decided to leave well alone.

  A year later, Elsie Turner and Angus Marshall married discreetly in an Edinburgh church, far from Ayrshire. They returned to live in his mansion on the banks of the Cree, the spot where Olive died in full view of their lounge window.

  Over the next thirty years I had no occasion to be involved with them until she was in her sixties and he in his eighties, when I was no longer in full-time practice. Angus Marshall telephoned me one evening when I was the duty doctor in the Ayrshire 24-hour On-Call service. He was glad it was me. Could he possibly come to see me at my home, that evening?

  He arrived about half an hour after the call. He was older, and had more worry lines etched into his face, but he was still lean and fit.

  I welcomed him into our lounge and sat him down with a small whisky.

  ‘I’m not sure if you can help us,’ he said, ‘but I don’t know who else can. You see, you have known Elsie longer and probably better than anyone. There may be something you can say or do that can rid her of her nightmares.’

  ‘Nightmares?’ I asked.

  ‘For years she has been depressed. She mopes about the house worrying and muttering. In the last few months,’ he continued, ‘she has been having terrible nightmares. She wakes up terrified, and doesn’t want to go back to sleep, in case the nightmare starts again.’

  ‘Has she seen a psychiatrist?’ I asked.

  ‘She won’t see one,’ he replied. ‘She says there’s nothing anyone can do for her.’

  ‘She hasn’t tried to harm herself?’

  ‘That’s the funny thing. She is so depressed that my sister, who was a psychiatric nurse, did ask her whether she had thoughts of suicide. At that she went right off the rails, shouting that it would only precipitate her into hell. Do you think you could come to see her, in a private visit, some time?’

  I thought about that for a few minutes.

  ‘Does she know you have come to see me?’ I asked.

  ‘Good God, no,’ he said. ‘I’m doing this off my own bat. She would be furious if she thought I’d asked you.’

  ‘Then maybe I’m the wrong man, Angus. If she needs help from me she needs to ask for it herself. She really needs a minister or a truly expert psychiatrist. I’ll give you a few names, but if you would like her to see me please ask her first. I’ll come if she says yes.’

  The invitation never came. Instead the next day at about ten o’clock in the morning their doctor telephoned me. I wasn’t surprised, because she would have received my faxed records of the conversation when she came on duty the next morning.

  ‘Hi Tom,’ she said, ‘I see you spoke to Angus Marshall last night.’

  ‘Yes, though it was really about his wife, not himself.’

  ‘I understand that. But did you hear what happened later?’

  ‘No.’

  ‘You are sitting down, aren’t you?’

  ‘Yes – why?’

  ‘Elsie took a kitchen knife to him this morning. Just after he said he had been to see you.’

  ‘What? How do you know?’

  ‘He told us. Luckily she isn’t very strong and her aim wasn’t good, so she only pierced his shoulder, and missed anything vital. He was able to subdue her, and she’s in the Arran.’ The Arran is our emergency psychiatric unit.

  I never discovered why Elsie became so upset about his meeting with me – but I think I can make a guess that’s not too wide off the mark.

  Chapter Seventeen

  ‘Twas Christmas Day in the practice, and the patients all sat on the stairs…

  Christmas Day wasn’t a holiday in Scotland in the Sixties. I learned that the hard way. Assuming that no one would expect a surgery on my first Christmas Day, I walked downstairs that morning in my dressing gown and slippers to make coffee and toast, to find six men waiting in the hall. It was only two months after moving in to the Collintrae house, the planned waiting room wasn’t yet ready, and the hall had had to do in the meantime. It was comfortable enough, with a Rayburn stove and plenty of chairs. The overflow could sit on the stairs if they wished – in fact, two of them were doing just that.

  The men clearly expected me to be working as usual and, as some of them had come several miles, I didn’t want to disappoint them. I quickly ran upstairs, put on my clothes and arrived, a bit breathless, a few minutes later, to start the surgery. No one bothered about this strange behaviour, presumably because the young doctor from England was a bit green yet, and didn’t know the rules.

  What I hadn’t known was that for most of the men, Christmas Day was their only official break from their duties as dairymen or shepherds, at least at my normal surgery times. It was the one day in their year in which they could grab an opportunity to do important things – like seeing their doctor.

  That was Christmas 1965. From then on I did hold a surgery on Christmas morning, but I let nurse Flora spread it around in her masterful way that it was for emergencies only. As each Christmas passed, and the social climate changed, there were fewer and fewer Christmas attendees.

  On Christmas Day 1967, I had just one patient to see. He brought in a problem quite unlike any other I have ever had. Charlie Welsh was the physics teacher at the local academy in Girvan. He was good at his job, because the school had excellent ‘Highers’ results, with many of the pupils, boys and girls, going on to study science at university. His real love, however, was birds. Every day, before driving the fourteen miles to the school, he would walk a few miles along the shingle beach, noting the numbers, types and behaviour of the birds he saw. The shingle bank to the north of the mouth of the River Stinchar is home to nesting terns, and it was to Charlie’s credit that it was made a site of special scientific interest and protected for the foreseeable future.

  That Christmas day Charlie sat down in the surgery and pulled out a package from the inside pocket of his overcoat. He unwrapped it to reveal a dead grey-backed gull.

  ‘What do you make of this, Doc?’ he asked.

  ‘Well, Charlie, it seems to be dead,’ I said, grinning at him. ‘I’m not sure I’m qualified to tell you more.’

  ‘There are thousands more like it on the beach,’ he said. ‘And it’s not just grey-backs. There are fulmars, kittiwakes, black-backs, shags and cormorants – all of them dead. They’ve appeared in the last two or three days. There are a few still alive and staggering around, choking as if they can’t breathe. They have bubbles of mucus around their mouths, and I could swear that some of them are coughing.’

  I looked at the dead bird again. I was obviously no expert, but the mouth was flecked with mucus and even tiny spots of blood.

  ‘I suppose they could have some form of pneumonia,’ I said, ‘with bleeding into their lungs, but I’ve no way of telling. Why don’t you let the vets know?’

  ‘They aren’t interested in dead gulls,’ he said. ‘They’d just laugh. I wondered if you’d be able to thr
ow any light on them.’

  ‘I don’t know that I can, short of doing a post mortem on it, and even then I wouldn’t know what I was looking for. And I’d be a bit concerned about close contact with the bird’s tissues. It could be botulism – poisoning from scavenging on the rubbish tips when sea food is low. I wouldn’t want to expose myself or you to that. I don’t know, either, whether germs from dying sea birds can be transmitted to humans. If it is a form of pneumonia, the only one I know that does transfer between birds and man is psittacosis, bird-fancier’s lung, and that’s a chronic chest disease, like chronic bronchitis. To be frank, I don’t think you should be handling the birds. I couldn’t tell you for sure whether there’s a risk or not, and it would be better to be safe than sorry.’

  ‘I’ll do what you say, Doc,’ Charlie said, lifting the bird and wrapping it up again in the paper. Then he added, ‘I’ve seen botulism before, and it isn’t like this. The birds stagger around, semi-paralysed, then lie on their backs and wave their legs and wings about, weakly, till they die. It doesn’t take long, and they don’t cough or produce this amount of mucus around their beaks. In any case only gulls scavenge – shags and cormorants eat only fresh fish, so they aren’t exposed to botulism. My hunch, like yours, is that it’s some form of infection, but it must be pretty powerful to hit so many birds of so many species, all at once. Could it be pollution – say a poison in the sea, a discharge from shipping?’

  ‘The only kind of discharge like that would be oil, wouldn’t it?’ I said. ‘And there’s no spill, is there, on the beach?’

  Charlie shook his head.

  ‘There’s just one thing nagging at me,’ he said. ‘I’ve seen this once before, around ten years ago. Thousands of dead birds, around Christmas time. We never found the cause then. It took years before the populations of the different birds climbed back to normal. When I go home I’ll look up my records to see when it was, and I’ll let you know.’

  He turned to leave.

  ‘Oh, and by the way, Merry Christmas,’ he said. ‘I hope you aren’t too busy.’

  ‘Thanks,’ I said, ‘and Merry Christmas to you, too. So far I haven’t any calls, so the signs are good.’

  Charlie left and I walked from the surgery through the short corridor to the main part of the house, sat down to have a coffee and to open the presents with Catriona, now two- and-a-half and a really active toddler, and Alasdair, who at fourteen months had just started to walk. Mairi was speaking on the phone.

  ‘You have a call,’ she said, once off the phone. ‘It’s at a place called Auchencleoch. It’s one of the forestry houses on the hill road from Braehill to Glencree. Two youngsters have really bad coughs and are finding it difficult to breathe.’

  ‘Youngsters? How old?’ I asked her.

  ‘Early teens,’ she said. ‘Their names are John and James Dougan: their father called. He is Daniel, his wife is Agnes, but I can’t find them in the records. They must be new. He thinks the boys need urgent treatment. They haven’t been ill like this before.’

  I looked at the Ordnance Survey map for the district. The Braehill to Glencree road snaked up into the hills along the river valley for twenty miles. It took me a while to pinpoint Auchencleoch, hidden in the narrow contours a good three miles off the road, with a single dotted line winding up to it.

  I screwed up my face. Single dotted lines meant an unmetalled single track road, probably with gates and cattle grids, and usually plenty of potholes. I had never been called to the house before, and hadn’t even known that people lived there, so far out of the way. I left Mairi and her mum, Bessie to prepare the Christmas dinner, and walked out to the car.

  It was one of those cold, frosty days with no cloud in the sky. The sun shone, but there was no heat in it. It took me twenty minutes to reach the makeshift sign on the Braehill to Glencree road that pointed the way to Auchencleoch. I blessed the weather. I had been right about the dotted line. The single-track road would have been a quagmire if its surface hadn’t been solidified by the frost. I had to slow to around five miles an hour and sometimes slower to navigate over the ruts, the holes and the rocks. Twice I had to get out to open and shut gates, put there to keep sheep in and deer out of the grazed moorland. About a mile along the road the forest started, and the track improved a little. Auchencleoch was two miles into the forest.

  The house, small and four-roomed, with smoke rising from the two chimneys, one at each gable end, had seen better days. The white paint was peeling, revealing patches of the grey stone underneath. Littered around the sides were rusting relics of farming and forestry machinery, and an old car that hens were using as a roost. There was no attempt to make a garden, though there was a square of ground a few yards away with some sad leeks and Brussels sprouts sparsely poking up from the frosted soil. Beside it a washing line held an assortment of clothes, white and stiff as boards. In a small paddock was a dejected donkey. Beyond was a pond, on which were some birds, possibly geese, maybe swans. They were just too far away to be seen clearly.

  I walked to the door. Before I could knock a man in his fifties greeted me, and led me into the main room. He was big and burly, in a shirt opened at the neck, a waistcoat, and old, baggy, thick tweed trousers. He hadn’t shaved for days, and looked tired and drawn.

  A woman, thin and careworn, was sitting by the fire. She was about the same age as the man. I assumed she was Agnes. She smiled at me, but didn’t rise or introduce herself.

  ‘Dan Dougan,’ the man said. ‘Thanks for coming. I’d like you to see the boys. They have got really bad colds, and can’t shake them off.’

  Bad colds, I thought, and he wants me to come all this way, on Christmas Day, just for that? But I was polite, smiled back at him, and let him lead me to the boys’ room. They were lying side by side in single beds. They were flushed, finding it difficult to breathe, constantly coughing, and holding their heads as they coughed. They told me that they had felt ‘awful’ for several days, had had shivers and sweats, had pains in their limbs and back, headaches, and couldn’t breathe easily without their ribs hurting.

  I listened to their chests, took their temperatures and pulse rates, and knew I wasn’t dealing with colds. They had true influenza. I was curious about this, because they were the first cases in the district. In fact I didn’t know of any cases in Scotland. There was nothing about an impending epidemic in the medical news or on the medical gossip grapevine.

  Stranger still, the boys hadn’t been anywhere to catch the ‘flu. They had not been at school recently, they said, and in any case it was now the school holidays. They had been in and around the house for the last month, and had met no one. The furthest they had been was to the pond to try to bag a bird.

  ‘And did you bag one?’ I asked.

  ‘No,’ the older one, John, said. ‘There were a few dead ones lying around, so we thought they might be poisoned. So we left the rest alone.’

  ‘Why would they be poisoned?’ I asked. ‘Who would do that?’

  ‘The local gamekeepers leave poison around for the buzzards, and we thought it might have got into the water,’ said James. ‘So we kept clear of them after that.’

  ‘Did you touch any of the dead birds?’

  ‘We buried four of them, just in case any animals might eat them and get sick themselves. So we touched them. But we washed afterwards.’

  Curiouser and curiouser, I thought, then turned to their father.

  ‘They both have chest infections, probably ‘flu,’ I told him. ‘I’ll give them antibiotics for now, and you can come to the surgery after Boxing Day for some more. Keep them in bed for the next two days and give them plenty of food and drinks. They’ll take a while to recover completely, but they should be fine.’

  He thanked me, I said goodbye to the boys, and we walked back into the main room.

  A much younger woman had joined Agnes by t
he fireside, sitting beside her in an easy chair, her arms across a very large abdomen. I walked over to her and smiled.

  ‘When’s the baby due?’ I asked.

  ‘It’s not very long now,’ said Agnes. ‘A few days, I suppose.’

  ‘So, are you visiting?’ I asked.

  The younger woman looked puzzled.

  ‘Why do you think that? I live here,’ she replied.

  ‘Then why haven’t you been to see me?’ I asked. ‘Have you at least seen the nurse?’

  ‘Oh, no,’ said the older woman. ‘We like to do this our way – we don’t like clinics or hospitals for a natural thing like having children.’

  ‘Natural isn’t always the best,’ I said. Turning to the young woman, I asked if she minded if I examined her. She didn’t. In fact, she looked relieved.

  I was shocked to find that she was in early labour and had a blood pressure that was going through the roof. If I didn’t get her into the maternity unit in Girvan fast, we might have a tragedy on our hands. Her blood pressure rise meant that she was at extreme risk of having convulsions if we couldn’t bring it down, and we plainly couldn’t do that in Auchencleoch.

  First, however, I had to know who she was. She didn’t appear on my list of people signed to the practice. Dan explained that she was his step-daughter Carol, the daughter of Agnes by a previous marriage. I didn’t ask about the father-to-be, sensing that the answer might be difficult. Nor did I waste time probing why she had had no antenatal care.

  I explained to them why she needed to be in hospital, and used their phone to dial the ambulance service. The only available ambulance would take forty minutes to get to the house, so I decided to bundle her and Agnes in my car, and meet the ambulance on the way. We left Dan to look after the boys.

  Being rumbled about on a forestry road when in labour doesn’t calm things down. Halfway to Girvan I had to stop to tend to Carol, who was now ready to push. As luck would have it, we were outside the only inn on the road. It would be easier to deliver the baby in a bed than in the car, so I sent Agnes off to the front door for help. She came back within seconds.