She was clearly confusing me with someone else. I waited until she had finished rambling and then I asked her what was the matter.
“Nothing,” she said, as far as she knew. She felt all her limbs as if to see if she had overlooked a broken one.
“But why did you send for me?” I asked. “Mr Pankrest said you wanted me to call.”
Her blue eyes, ringed with a fence of black mascara, popped wide.
“But that was last week,” she shrilled. “I can’t remember exactly what it was I was suffering from at that dinner of Poppy’s; I was sitting next to Willie, delightful boy, but anyway, whatever it was, it’s quite, quite better.”
I picked up my case.
She sat forward. “Oh! no. Don’t go,” she said. “While you’re here you might as well give me a thorough overhaul. It must be three weeks since that money-grabber Doctor Anstruther went right over me, and then he had the cheek to tell me I was as fit as a fiddle when he knows perfectly well how I suffer with my head and my abdomen. Sometimes I wonder whether you doctors know anything at all or whether you just pretend with all those fancy names you don’t want us to understand.” She stood up. “Will you have me on the bed?”
I unwound my stethoscope and said “Yes,” I would have her on the bed.
By the time I escaped from the Hon. Mrs Magnus-Wight’s it was after one o’clock. I still had half my visits to do and had not had any lunch. I was grateful to Wilfred for one thing. I knew now that I would never swap one Mrs Jones, Mrs Pickle or Mrs Catterwell for ten Mrs Magnus-Wights. I was temperamentally suited to my own practice and could never stand the mumbo-jumbo of Society medicine. If my patients were suffering from a chronic complaint for which there was no known cure, I liked to explain this to them while perhaps prescribing some palliative treatment. I could never stand by and watch them pay for endless “courses” of injections or physiotherapy at the end of which the condition remained unchanged. I was aware that this was what the private patient wanted, but there were other doctors, more suited to the task than I, very willing to provide it for them. To me a sore throat was a sore throat and could never be acute pharyngitis, no matter how much the patient was willing to pay me to tell him so.
On my way home I rang Sylvia from a call-box to see if there were any urgent calls to do or whether I could come home first for lunch. George Leech, she said, had one of his funny attacks, and could I go as soon as possible. Lunch would have to wait.
George, who had phoned me every week since trying to sell me the American convertible, with tempting offers of second-hand bargains (by some strange coincidences always owned previously by vicars or old ladies), and first-hand extravagances, was having, as I thought he would be, one of his usual attacks of pain. As I examined him I saw him watching me shiftily and knew that he was expecting me to deliver my usual lecture.
George, we had discovered by means of a sigmoidoscopy, had a slow-growing malignant tumour of his colon. He had been told, many times by me and twice by surgeons to whom I had referred him, that since it was in the early stages, the growth could be removed surgically with an extremely good prognosis. George, however, was one of those fortunately rare people with an almost pathological fear of surgery and absolutely refused to allow himself to be “cut up.” He was impervious to pleas, threats and the most forthright account I could manage of what would happen to him if he continued to bury his head in the sand. Neither I nor the knowledge that the tumour would most certainly kill him if he delayed too long could move him. Even his occasional attacks of pain failed to persuade him.
I gave him a tablet to relieve the pain and sat down on the end of the bed to wait until it began to work.
He lay back on the pillow and looked at me from beneath his lowered eyelids. “Well?” he said.
“Well?”
“Arencher going to say it?”
“I’m fed up with saying it, George,” I said. “Surely your pain must remind you of what’s going on inside you. Let me arrange for you to go into St Anthony’s for operation. You’d be out in three weeks and there’d be no reason why you shouldn’t be flogging cars thirty years from now.”
“Over my dead body, Doc.”
“It will be, George. Look, if something’s wrong with a car engine you have it repaired, don’t you? You don’t wait until the car packs up.”
George grinned. “That’s what’ll happen to your tin can if you don’t watch out. Find yerself sitting in the middle of the road one day wiv no back axle. Why’nt you let ’er go, Doc? I gotta lovely silver-grey saloon, twenny-five to the gall…” His voice was becoming blurry as the tablet began to work.
“Can’t afford it just now, George,” I said, and indeed with a forthcoming increase in the family I would have to start saving up. “But it wouldn’t cost you a penny to have your operation.”
He was drifting off to sleep. “You buy a new car offa me,” he said, “an’ I’ll consirrer the marrer…”
I got up and stood over the bed. “George,” I said, “I wish you realised that your life is in danger, not some miserable back axle. It’s a different thing altogether…” He was asleep. I knew that even if he had heard it would have made no difference. He had heard it all before.
Since it was already so late I decided to stop for a cup of coffee at the “Playfair,” then finish the rest of my visits before going home. As I walked into the restaurant, Archibald Compton was paying his bill. I wanted to ask him why he now had the Hart family on his list, but I could hardly do it in front of the cashier. We nodded to each other and I sat down. Doctor Compton finished paying his bill, then came over to where I was sitting. “Ah!” I thought, “he’s coming to explain about the Harts.” He put a hand on my shoulder and bent towards my ear.
“Try the toad-in-the-hole, old man,” he said. “It’s awfully good.”
Nine
Since Sylvia was now about three months pregnant, I had to decide whom I was going to ask to deliver our baby. Whilst many of my patients had their babies at home, or in hospital (in the case of first babies or special cases) under the Health Scheme, there were many who preferred to pay for the more individual attention of a particular gynæcologist whom they attended privately. During the time I had been in general practice I had become on increasingly familiar terms with three or four gynæcologists, each of whom I was sure would be only too pleased to look after Sylvia. Apart from the fact that doctors were always willing to look after a colleague and his family, my choice of specialist for my wife implied a tacit agreement that I would continue to send my gynæ. cases to him. The specialist in private practice still, of course, depended upon the general practitioners for his livelihood; he could see no patient unless that patient was referred to him by a GP.
The subject of medical etiquette is a prickly one and one which often mystifies the layman. The public, by and large, understand medical ethics (professional secrecy, refusal of one doctor to treat a patient already under the care of another without permission), but many people are still baffled by the reasons underlying medical etiquette. They are quite unable to grasp why they should not go and see Dr So-and-so about their heart without all that hanky-panky (as it seems to them) of going to their own doctor before and after their visit to the specialist. They do not appreciate that the rules of etiquette are made for their own good and that it is vitally important to them that the family doctor remains in control. They view the whole procedure with suspicion as though the rules had been drawn up to protect the vested interests of the doctors, and tend to forget that if they are taken seriously ill on a Saturday night it will be the family doctor who will have to treat them and not the consultant.
Usually each GP referred his patients to one of a small group of consultants in whose ability he had faith, and as the years rolled on a letterhead romance began and blossomed. To the newly qualified GP, sending his first patients to the consultant of his choice, the opinion would return under the formal greeting: “Dear Doctor Smith.” Many months, and a few
opinions later, the courtship would advance a stage further: “My dear Doctor Smith,” followed at not too long an interval by “Dear Smith” and “My dear Smith.” At this stage in the wooing, practitioner and consultant might possibly meet in order to discuss a case with the inevitable outcome: “Dear John.” By the time “My dear John” terms were reached the partnership was sealed and could look forward to many happy years of successful cooperation.
After nearly two years in general practice I was on first-name terms with three gynæcologists when I had to decide about our own child. I discovered that it was one thing to choose a consultant for a patient, quite another when it came to one’s own family. My cool powers of decision had gone and I felt quite dithery. Since each one of the men I was considering was equally competent, obstetrically speaking, it seemed to boil down to a question of temperament. Each patient looked for something different in her gynæcologist, as she did in her GP. As a colleague of mine once said: “I always send the weepy ones to so-and-so,” which put the whole matter in a nutshell.
Of the men I was considering asking to look after Sylvia, one was a forthright Irishman, superb at his job but who never molly-coddled a patient; one was a smooth young man who described to me in detail in his letters each loving stitch or whiff of anæsthetic he had to administer – his patients adored him; and the third was a huntin’, shootin’ and fishin’ nobleman in his sixties who had come to the house once when I had called him out to see a patient of mine, and sat taking notes about her while I had my dinner. Unfortunately he had not at first put a book or a newspaper under the sheet on which he wrote, and we still had the legend “Miss Baker is a virgin” imprinted in his flowing hand on the polished top of our dining-room table.
Since I had great faith in the skill of each of these men, I decided to leave the final choice to Sylvia. She did not take long to make up her mind. She liked being molly-coddled, she said, but not by old men. Together we went to see Mr Humphrey Mallow.
Put by one sympathy-exuding, crisp, white receptionist into the hands of a second sympathy-exuding, crisp, white receptionist, we were finally ushered into the vast, high-ceilinged sanctum of Mr Mallow, who, meeting us at the door, guided Sylvia like a piece of rare old china to a chair, gave me a curt nod, and went to sit behind his desk.
“Now,” he said, pen in hand, showing Sylvia a complete upper and lower set and two brown eyes loaded with compassion, “what is the full name?”
It was no wonder they fell like ninepins under his charm. I had plenty of time to examine the beautiful room, his books, his flowers, photographs of his wife, oil-paintings of his children, while he had a heart-to-heart talk with Sylvia. When he had finished I felt sure that she, like the patients I had sent him, would be his slave for ever. He sent her with the nurse, summoned by a discreet bell, into the examination room and then, and only then, turned to me.
When the nurse told him that Sylvia was ready to be examined he excused himself and glided out. I nipped round behind his large desk to see what he had written in his notes about Sylvia. He had one full page of information noted down in his detailed and precise way. At the end of the page he had written in capital letters: BOY. It was an old dodge of gynæcologists. They wrote BOY, large and clear, in their notes and then told the patient categorically that she was going to give birth to a girl. If a girl was born all was well; the patient much impressed with his diagnostic powers; if a boy arrived, he would conveniently forget what he had told the patient and proudly produce his note made unmistakably at the time of the mother’s first visit. It was a simple wangle, but either way he couldn’t lose. Mr Humphrey Mallow was obviously not going to miss a trick.
I was still on the wrong side of the desk when I looked up to see the nurse, who had crept silently in on the thick-piled carpet, looking at me disapprovingly. I tried not to look like a guilty schoolboy and, putting my hands in my pockets, whistled a little, going on to examine the flowers as if I had been merely taking an inventory of the whole room.
“Mr Mallow says would you like to come and have a look at your wife,” she said.
I wanted to tell her that I had seen my wife before, but followed her large white feet out of the room.
Sylvia, partly undressed, lay on the examination couch. Mr Mallow was rubbing his hands and beaming at her.
“Everything seems fine,” he said; “we should have no difficulties here. She seems to have about a twelve-week pregnancy. You can just feel the uterus over the brim of the pelvis.” He pushed back the towel on Sylvia’s tummy and felt. He then invited me to have a feel. After I had confirmed his findings and winked at Sylvia, Mallow said: “By the way, how did that patient of yours, Mrs Plowright, do on that testosterone I gave her?”
Mrs Plowright had an interesting gynæcological condition which had been causing her trouble for many years. I thought that Mr Mallow was at last helping her, and told him how she was progressing with the treatment he had prescribed.
“It reminds me of a very similar case I had when I was in Newcastle,” he said, and began to tell me about it. When he was only halfway through a voice from the couch said:
“Do you mind if I get dressed now?”
We both looked at Sylvia. Mallow was instantly all contrition.
“My dear girl,” he said, “how stupid of us.” He smiled at her disarmingly. “You know how it is when we start talking ‘shop.’”
“Yes,” Sylvia said resignedly, she knew how it was.
While Sylvia got dressed I went back with Mallow to the consulting-room. Sitting at his desk he made notes on his findings by examination.
“Everything all right?” I said casually, more to make conversation than anything else.
I was surprised when he didn’t answer immediately.
“I’m not very happy about her blood pressure,” he said, stroking his chin. “The diastolic was a hundred and ten. We shall have to keep an eye on her.”
I felt depressed. Although there was no immediate danger, if Sylvia should turn out to have high blood pressure it was a worrying condition which could lead to complications, and she would have to be very carefully watched.
“Cheer up,” Mallow said. “I’ve delivered many doctors’ wives, and they all seem to develop some peculiarity or other with which to plague their husbands. The best thing is to let me do the worrying. I’ll look after Sylvia.”
He was kind, but I was still upset. We decided not to say anything about her raised blood pressure to Sylvia, but that I was to watch her and make sure she did not tire herself.
Outside on the marble, pillar-surrounded step I asked Sylvia how she had liked Mr Mallow.
“I think he’s charming,” she said. “But next time, if you don’t mind, I shall go alone.”
“Why?” I asked, hopping nimbly round to walk on the outside of the pavement.
“Because I don’t like lying there as if I was in the cattle market while you two discuss my attributes.”
I laughed. “You’ll get used to it,” I said airily; “all doctors’ wives do. Anyway, he says you’re going to have a lovely baby.”
“A girl,” Sylvia said. “I hope he’s right. Little girls are adorable.”
I didn’t tell her about the “BOY” Mallow had written in her notes, nor that I rather fancied a boy myself. She was in rather a touchy mood these days and there was no point in upsetting her. Anyway, we would, I hoped, have more than one child, and would ultimately both get what we wanted.
Driving home we made a provisional date for our dinner party at which we were to introduce Faraday to Tessa Brindley, and discussed the menu and guest list. We dismissed half our friends as too dull, too stuffy or too old to provide a light-hearted setting for the romance we were hoping to bring about, and finally decided upon Sylvia’s friend Molly, for colour, and her new, long-haired artist boyfriend, for intellect. The party was to be completed by my old friend Loveday, the dentist, and his wife, who were always excellent conversationalists and good mixers.
The food problem was not so easily resolved, because at every suggestion I made Sylvia said she felt sick. She had been suffering from nausea for the past few weeks, and said that if she didn’t feel any better by the night of the party she would just have to sit in the kitchen with her tea and toast while we tucked into our roast duck or tournedos or whatever other cannibal-like dish we decided on. On second thoughts, she said, we should probably all be drinking tea and eating toast because she couldn’t even bear to cook anything fit for a dinner party, and the most Iris could rise to was the frying pan, out of which she and I were at present living.
I promised her that in another couple of weeks her nausea would have disappeared completely and that she would most probably be thinking of nothing but food and eating – as my pregnant patients assured me they were – “enough for two.” We decided to leave the menu until a later date.
As we drew up outside the house I saw Iris’ burning bush of hair pushing aside the dining-room curtain. She came bouncing out of the house to meet us.
“Oh! Doctor,” she said, “I’ve got a man in the waiting-room with his neck all like this.” She twisted her head until it was grossly contorted. “He’s in terrible pain, but I sat him down and said you’d be sure to be able to put it right.” Iris had implicit faith in my healing powers. “I’ll get your case,” she said, and made for the car.
“I shan’t need that, Iris,” I said. “Go and tell him I’ll be with him in a few minutes.”
Mr Westbeech, our good-looking local librarian, had a cervical disc lesion and was, as Iris had said, in severe pain.
I decided to try and manipulate it for him and told him to lie on the couch with his head at the foot end. Getting into position behind his head, I asked him to hold on tightly to the sides of the couch while I pulled his head. It was no good. Every time I pulled, his hands slipped against the leather of the couch and he slid towards me. I needed someone to assist me by holding his shoulders. Asking Mr Westbeech to lie still for a moment, I went to find Sylvia.
Love on My List Page 8
