Practice Makes Perfect

by Rosemary Friedman

  “The absence of fever, and indeed of tachycardia, should never prevent a diagnosis of acute appendicitis. I would certainly advise a check on temperature and pulse rate, but even if one or both are normal, in the presence of other signs and symptoms of acute appendicitis one should not be deterred from making the diagnosis and hospitalising the patient with all speed.”

  “What are your views on exercise after myocardial infarction, Dr Perfect?”

  He looked at me for a moment and I thought I had found him out; the previous question could, at a stretch, have been answered by an interested layman.

  “Not everything that counts can be counted, man. If general practitioners were willing to observe their patients during walking, the initial speed, the period of adaptation, and the maximum speed could be determined. In this way much cardiovascular invalidism could be prevented. No patient should exercise at maximum speed, not even experimentally and under electrocardiographic control. Training on an ergometer bicycle is tedious and unnatural, unphysiological and dangerous. The patient must be re-educated. Your Consultant can’t do it, man. Your GP can.”

  I pictured him walking the streets with our numerous sufferers from coronary artery disease and was beginning to believe that he actually would. The more we talked the more I realised that Fred Perfect was not only well-up in his medical knowledge but genuinely concerned with people as human beings. He felt that our present system of medicine had become de-humanised and that our obsession with medical science and technology gave a producer-orientated service, the source and generator of runaway medicine. He believed that as a long term policy we had to take care of our aged by beginning with today’s thirteen-year-olds.

  “These kids want to know about people, about love, about drugs, about children. This doesn’t mean they want to fly, man, just to know a little more about how people tick over. It’s vital to know, man. No schoolboy is going to run to the bathroom to wash his hands for all your spiel about germs, man, but he has to know. Our false moral systems of ecclesiastical-engendered guilt complexes on the one hand, and the religion of success on the other, have drained this country of its real physical and emotional energy. ‘I’ve given him everything from the day he was born!’ Yes, man, everything that could be dimensionally measured and priced, man, but what about love? That look of genuine interest and affection that every child seeks in his parents’ eyes. They’ll soon be parents, man. We learn our attitudes from our parents who learned them from theirs. We have to prevent disability and breakdown, man. Quit studying animals and their behaviour, man. Every person needs love.”

  We discussed antibiotic resistance, asthma and varicose ulcers. We spoke of medicine and mass media and Fred’s sincere opinion that surgery is almost always a crude make-shift which had to continue only until such time as more effective methods became available. By the end of an hour I was beginning to warm to Fred. After an hour and a half I almost believed in him. I accompanied him to his taxi and said that if he really wanted to become my assistant I would check his references at once and contact him. As he got into the driver’s seat I said:

  “Your parents, Fred? What about your parents?”

  “Man of God,” he said turning his eyes to heaven, “and ‘work-my-fingers-to-the-bone-helpmeet’.”

  He started the engine and yelled: “If you can’t turn your parents on, plant them.”

  He made a fast U-turn in the road. I wondered if I had heard correctly.

  I made inquiries about Fred. It appeared he had begun his medical career quite normally winning a scholarship from Grammar School to University. It was only in the past six months that he had “dropped out”, no one seemed able to account for it, but all three of his chiefs to whom I spoke, while unable to fault his mental acumen and knowledge of medicine, seemed quite relieved that he had decided to go into general practice to which they all believed, despite his peculiarities, he would prove a genuine asset. On this point I had to admit that my feelings were mixed. As I did my daily visits I tried to imagine Fred in my place. Would he talk to Miss Lacey, riddled with inhibition and crippled with arthritis, of love? Would he be allowed over Colonel McAdam’s threshold in his flowered shirt and sandals, or be told politely no thank you they didn’t want any today. Would he get anything but howls of derision from Penny Marsh with measles? Would Richard Wall allow him access to his stitches? Jennifer Mitchell I guess would scream had he entered her bedroom in his fancy gear. But as Sylvia said, beggars can’t be choosers. Besides which she thought he was awfully nice.

  I was outnumbered. Not only Sylvia, but the twins begged me to take him. At twelve years old they considered themselves judges of human nature, of which they saw more than their share in our house, and declared him dishy, dolly, divine, fab, fantastic, groovy and other things which I was not quite sure were going to prove assets in a general practitioner. I stood alone in my unease concerning Fred. As I passed Drs Murphy, Miller, Hobbs and Entwhistle out on their rounds as I did mine, I wondered what their reaction would be to Fred in his purple taxi and whether they would be willing to include him in the weekend rota.

  Feeling myself rapidly disintegrating from exhaustion brought about by overwork from trying to run the practice single-handed, I yielded to necessity and ignoring my misgivings and inner promptings of caution, notified Fred and the authorities that from the following week we were to work together.

  Fred said that I was a cool male and when would the pad be vacant, and the Executive Council acknowledged his appointment in more conventional terms. I asked Sylvia when we could move into the Bay Tree House she had set her heart on and after much evasion she admitted that they had only got as far as the foundations. She was sure however that it would be no more than a couple of months. She had more faith in the British workman than I. Penny and Peter were ecstatic, both at the prospect of moving and the coming of Fred, and Eugénie, who could do no more than wave her arms and give little toothless smiles, made no comment at all. I told her that she was the only one in the house with any sense, at which she gurgled, and that Fred would in all probability last no longer than a week, at which she started to scream, bringing Sylvia at the run.

  “What did you do to her?”

  “Twisted her arm!”

  She whipped her out of the cot. “What did Dad-dad do then?” She looked at me accusingly.

  “Freud would have a thing or two to say about you,” I said.

  “Well, fortunately he’s not here to say it. You sound like Robin with all that codswallop.”

  Robin had been interested in psychiatry.

  “Sylvia, I don’t know what’s happened to your language lately.”

  “And I don’t know what’s happened to you.”

  I held out my arms for the baby. “Let me hold her for a minute before she suffers some irreversible damage from your castigation of her father.”

  “Irreversible rubbish. You’ve got measles, mumps and goodness knows what else all over you.”

  I removed my jacket and flung it over the cot from which Sylvia removed it with two fingers as if I had been in contact with typhoid, leprosy and smallpox all in one morning. I cradled Eugénie and she burped stale milk down my shirt. I quelled Sylvia’s sarcastic remark with a look and she claimed Eugénie back with that protective, jealous gesture common to every mother in the world.

  “You’d better change,” she said. “You smell to high heaven.”

  “It’s not worth it. Clean me up with a nappy. I’ve no more patients to see.”

  “There’s a girl in the sitting-room.”

  “What for?”

  “She says you asked her to call.”

  “Me?”

  “About the secretarial vacancy.”

  “What’s her name?”

  “Lulu!”

  “Lulu what?”

  “Just Lulu,” Sylvia said looking at me speculatively.

  I unbuttoned my shirt to the sounds of “Who’s Mummy’s little diddums then?” from the nursery. You woul
d think that Sylvia had never had a baby before. With the twins she had been reasonable; an almost super-competent mother. With our little adopted Eugénie she seemed to have gone quite berserk and thrown Dr Spock to the winds. She ruined her completely; did not let her whimper for a moment without picking her up, jealously guarded her from intruders and allowed no one but herself to feed her.

  “You are making a rod for your own back,” I warned her, but she was too besotted with Eugénie, who was a little darling, to hear me.

  I supposed that after Fred I should have been prepared. My last secretary, Miss Simms, fair, fat and fifty and worth two right hands, had retired to look after her mother in the Isle of Wight. As with Fred my advertisement had produced only one reply. Who wanted to work in a suburb when the big city waited, its pavements lined with gold? Some elderly personage whose family had grown up and whose shorthand was thick with rust, I presumed. I had not reckoned on Lulu.

  Like Fred she seemed out of her milieu. She would, I felt, have been more in place staring at me from the gossip page of a popular daily newspaper. I couldn’t be sure if she had a skirt on at all but I decided it must be one of the micro-variety, an abbreviated version of the mini. She had black hair which fell in a vertical waterfall from the crown of her head to her waist, giving the illusion that she consisted of nothing but hair and legs, both of excessive length. When she looked at me I discovered that in addition to these two not inconsiderable assets she had a pair of sapphire eyes, fringed but not masked by dense lashes I was wise enough to conjecture were not all her own.

  “I suppose you have impeccable references?” I sighed.

  She searched in which I presumed was her handbag but gave more the appearance of having come prepared to stay the night.

  “Would you like to see them?”

  Like Fred’s they could not be faulted. Who had imbued such sense of duty, efficiency, initiative and office management in one so young? Would my patients be willing to confide their needs for such unmentionable requirements as suppositories and elastic stockings to this child who would not look out of place at a school desk? Would the old, the sick, the distressed find sympathy in those mysterious sapphire eyes? I yearned for the comfortable solidity of the middle-aged Miss Simms. Had the world gone mad or was it I?

  “Tell me,” I said, “are you sure you want to work here? There is very little to interest a girl like you. Wouldn’t you be happier in a film studio or in town where you’ll meet people. There are dozens of exciting jobs available.”

  “Oh no, sir…”

  I shut my eyes with pain.

  “My husband’s a journalist, you see. He’s out all day and away from home a lot. We live round the corner in a maisonette and it only takes me an hour to clean right through. As you can see I’m a trained secretary and I can’t sit there all day staring at the walls. It seems such a waste of time travelling, so I wanted to find something nearby.”

  She looked scarcely old enough to have a husband. I guessed she had not had him for long and that this was their first home.

  “How long have you been married?” I asked.

  “Five years. We’ve just moved here from Purley.”

  I swallowed.

  “Are you quite sure that this is what you really want?”

  For the first time she showed some emotion and rearranged her extraordinary legs.

  She leaned forward confidentially.

  “What I really want, more than anything else in the world as you might say, is to have a baby. For the time being, however, I’d adore to have the job.”

  Three

  It was probably in self-defence that I accepted Dr Malleson’s offer. The character of my practice set-up, with the advent of Fred and Lulu after the comfortable conventionality of Dr Fouracre and Miss Simms, had altered to such an extent that I felt momentarily off balance and at odds with myself, the times and the “business” for which I was responsible.

  From the beginning Fred, aided and abetted by Lulu, had made his mark. His earliest innovation was a transistor radio in the waiting-room from which the “pops” blared forth from start to finish of every surgery. The consulting room doors were supposed to be sound-proof but it was almost impossible because of the discordant noises that filtered through the green-baize to hear what anyone was saying. I was sure that it was not only I who was inconvenienced but that the waiting patients would be mortally offended by the assault on their eardrums and would probably go home in disgust. On the first morning of the cacophony I strode into the packed waiting-room to switch off the noise and to my utter amazement was greeted with cries of, “Oh, Doctor, we were listening!” I tried compromising by lowering the volume a few decibels but was chided by Grandpa Tolley, who had come out without his hearing-aid and was waiting for his favourite song, and by Lulu, who snapped her fingers and rolled her eyes to the music as she gave out the Medical Record Envelopes and somehow against the horrible racket managed to make herself understood on the telephone. When Mrs Braithwaite refused to come in answer to my buzzer before she had heard the week’s Number One in the “Charts”, I began to wonder if I was running a surgery or a discothèque.

  The biggest surprise of all, however, was the universal popularity of Fred. I had predicted that the young people in the practice would welcome him with open arms and feel that someone of their own age who spoke their language was available to cope with their problems. The older people, I guessed, would view him with suspicion if not distaste and might very well resent his presence in the practice. I could not have been more wrong. On his first morning at work I decided in a mean and perverse moment to try him out on the Carter-Bells, a more “square” family than whom it would have been hard to find. Mr Carter-Bell was a stockbroker. He lived with his wife, Marion Carter-Bell, and his family, one boy, one girl, in a double-fronted house whose hydrangeas bloomed always to perfection and on time, and whose paintwork was renewed at precisely regular intervals. The house, under the aegis of Marion Carter-Bell, like her husband always faultlessly dressed, and a superior Spanish couple, ran like clockwork. There were always fresh flowers about and small dishes of sweets I’d swear were regularly dusted. No matter what time of day one called one never caught them or their surroundings in déshabillé. In winter they sat one each side of the electric fire with its glowing simulated coals, drinking coffee and eating After Eights; in the summer they were in their Ideal Homes garden with its striped umbrellas and white wrought-iron furniture relaxed, in so far as they were able in their clothes selected from a top London shop’s department of leisure-wear. On the terrace there was of course a barbecue where on Sunday mornings Mr Carter-Bell in his butcher’s apron grilled the steaks handed to him by the male half of the Spanish couple and allowed Mrs Carter-Bell to sprinkle the tabasco sauce. Richard and Fiona, true to the Carter-Bell tradition, were model students, dutiful children, and were never rude to their parents. It was the kind of household which made one want to scream or drop ash on the carpet. I am sure it was sheer maliciousness on my part, or perhaps envy for their perfection, that made me send them Fred. Mrs Carter-Bell was the patient. Mr Carter-Bell had naturally stayed at home since nothing and no one was allowed to proceed in the house without his personal attention. He had been present at the births of both his children, and supervised, I swear, each change of napkin. As they grew up it was he who chose their schools, selected their friends and watched over their progress at school. In addition to this he kept an eye on the kitchen, accompanied his wife to every fitting for every dress and dictated the interior decoration of every room, shopping personally for every ormulu door-handle. It was a wonder to me that the stock-exchange survived. Into this haven of rectitude I decided to introduce Fred, who had made no concession to conventionality on his first day as my assistant. True, he was not wearing the purple trousers but had substituted for them others in a kind of sick green with which he wore a raspberry shirt. Socks seemed to have no place in his wardrobe. I chuckled to myself as I imagined the expression o
n the face of Mr Carter-Bell and it did not come as a complete surprise when less than an hour after despatching Fred to examine his wife who had a “nasty cold” I received a telephone call from him. I had expected him to be angry. He was.

  “Doctor,” he said, “I asked for a visit this morning on behalf of my wife.”

  “Yes?”

  “She really has been very poorly indeed.”

  “I asked my new assistant, Dr Perfect, to call,” I said smugly. “Wasn’t he able to help your wife?”

  “Indeed,” Carter-Bell said. “It’s Manuel. The fool dropped the bottle on the way back from the chemist. I was wondering whether we might have another prescription in order to start the treatment without delay. We both thought the world of Fred.”

  I wished I had been a fly on the wall to discover how he had charmed the Carter-Bells. More than once I had heard them castigate the young people today with their long hair and pot as “worthless beatniks”. I hadn’t even imagined Fred gaining access to the house owing to his deficiency in socks.

  It wasn’t only the Carter-Bells. They all loved him. When the telephone rang the patients began asking either for Lulu or Fred. It sounded more like Joe’s Caff rather than a respectable medical practice. I had imagined attendances at the surgery falling off, patients removing themselves from the list. Nothing could have been further from reality. Each surgery was packed to capacity and we had many new registrations. I discovered by chance that this wasn’t entirely due to Fred’s personal charm or whatever it was that produced his undoubted magnetism.

  The first thing I noticed was that the type of patient seemed somehow to be changing. Interspersed among the old-age pensioners, the middle-class, middle-aged men, the starry-eyed young couples, the young mothers with young babies and the ladies who seemed permanently attached to their shopping baskets on wheels, were creatures from another planet. They came in boots, beads and bells, short skirts and shiny macs. They were interested only in seeing Fred, prepared to wait an entire morning if necessary, and they were all of the feminine sex.