The Proper Procedure and Other Stories

by Theodore Dalrymple

‘You see,’ said Ms Smith, ‘when old people have been in hospital for a little while, we can’t send them home just like that.’

  ‘Why not?’ asked Mrs Hardcastle.

  ‘All sorts of reasons,’ said Ms Smith. ‘For example – I’m just giving you an example, I’m not saying this will happen to you – they can go off their legs. Obviously, they can’t manage at home straight away if they’ve been off their legs.’

  ‘So they can’t go home?’

  ‘It’s not as simple as that. They have to go home in stages, as it were. They don’t need to be in hospital any more, but they’re not quite ready to go home either. But anyway, we’re here to talk about you.’

  ‘When am I going home?’

  ‘As soon as possible, of course. We don’t want to keep you here longer than necessary. Apart from anything else, we need the bed.’

  ‘When will that be?’

  ‘As soon as we can find somewhere for you to go.’

  ‘I can go home.’

  ‘To Sebastapol Villas?’

  ‘Of course, that’s where I live. Where else?’

  ‘Are you quite sure Sebastapol Villas are right for you?’

  ‘I’ve lived there all me life,’ said Mrs Hardcastle.

  ‘I mean, they’re very old-fashioned. There’s no indoor toilet. There’s no central heating. They’re just not up to standard these days. I don’t know how you’ve managed all these years.’

  ‘It’s my home,’ said Mrs Hardcastle.

  ‘I know,’ said Ms Smith. ‘But it’s time for something better. Something more comfy. You can’t go on living like that, not at your age.’

  ‘I’m used to it,’ said Mrs Hardcastle. ‘And there’s me gardin. I can’t do without me gardin.’

  ‘You could go to a place where there’s a garden that’s looked after for you. You wouldn’t have to look after it yourself. That would be a treat for you, wouldn’t it?’

  ‘I love me gardening,’ said Mrs Hardcastle.

  ‘But you’re too old for it now,’ said Ms Smith. ‘You could fall over – break your hip or something – and there’d be no one to help you. Until it was too late, of course.’

  ‘I’ll be all right,’ said Mrs Hardcastle.

  ‘That’s what everyone says until it happens to them,’ said Ms Smith. ‘It’s time to move on, Ivy. We’d all like to continue just as we’ve always lived, but circumstances change – we get older, for example – and we have to change with them. Sometimes it just isn’t possible to go on as before.’

  Mrs Hardcastle said nothing. Just then, the hearing aid of another patient, who had been inconspicuously dozing in the corner of the dayroom, began to emit a high-pitched whistle.

  ‘I wish she’d switch that thing off,’ said Ms Smith. Mrs Hardcastle, however, couldn’t hear it.

  It continued. Ms Smith had no choice but to go over to the old woman and ask her to turn it off. Unfortunately, she was deaf and Ms Smith had to shout at the top of her voice. When she returned to Mrs Hardcastle she appeared exhausted, and almost slumped down in the chair beside her.

  ‘As I was saying,’ she said, ‘I think it’s time for you to move on. You can’t go on living at Sebastopol Villas.’

  Mrs Hardcastle repeated that she would like to go home, and Ms Smith tried another tack.

  ‘Put yourself in my shoes,’ she said. ‘Suppose you were sent home from the hospital and something happened to you. You fell and broke your hip in the garden, for example, or froze in the outdoor toilet. How do you think I would feel then? To say nothing of the official enquiry afterwards.’

  Mrs Hardcastle didn’t know what to say.

  ‘You hadn’t thought of that, had you?’ said Ms Smith. It was a mistake to think that self-obsession was a characteristic only of youth. The old were capable of it too, not seeing things from other people’s perspective.

  ‘Wouldn’t you like me to show you places where you could go instead? Places where there’d be someone on call to help you twenty-four hours a day? Some of them are very nice.’

  Mrs Hardcastle evinced no enthusiasm and no opposition either.

  ‘Right, then,’ said Ms Smith, patting Mrs Hardcastle on the knee. ‘I’ll take you to see some tomorrow.’

  True to her word, she returned to the ward the following day.

  ‘First I’ll take you to Fallowfields,’ she said.

  ‘What’s that?’ asked Mrs Hardcastle.

  ‘Sheltered accommodation. You’ll love it once you see it.’

  Ms Smith took Mrs Hardcastle in her car and drove for about half an hour. Mrs Hardcastle was one of the few people left who had never ridden much in cars, and had to be shown the use of the seat-belt. She stared straight ahead, as if expecting disaster.

  Fallowfields was a collection of small bungalows at the end of a cul-de-sac. Each had a patch of grass in front of it, but no fence between, as there had been between the back gardens of Sebastopol Villas. There were also a few dead-looking rose-bushes.

  ‘Let’s go and see the warden,’ said Ms Smith brightly.

  In the middle of the bungalows was an office, a kind of brick hut. A black plastic plaque, with the word MANAGER on it, was fixed to the door.

  Ms Smith knocked.

  ‘Come in,’ the manager shouted, as if deafness was normal.

  They entered. The manager, an Irishwoman in her fifties, asked them to sit down. She had an open and pleasing manner.

  ‘Welcome to Fallowfields,’ she said.

  She brought a cup of tea for them from a kitchenette the size of a cupboard, and explained how things ran at Fallowfields.

  Every resident had her own home, with kitchen and bathroom, but there was a communal hall where everyone could meet if he or she wanted to (but there was nothing compulsory). There was a pull cord in every room to raise the alarm in case of emergency, and there was someone present to answer twenty-four hours a day.

  ‘In case you have a fall,’ said Ms Smith, who clearly thought that Mrs Hardcastle was, or was soon to become, unsteady on her feet.

  ‘There’s a doctor who visits every week,’ said the manager, ‘and a chiropodist.’

  ‘What’s that?’ said Mrs Hardcastle.

  ‘Someone to look after your feet,’ said Ms Smith.

  ‘Feet are the weak point of quite a lot of our residents,’ said the manager.

  ‘Their Achilles heel, in fact,’ said Ms Smith, and laughed.

  ‘Do you want to see one of the bungalows?’ asked the manager.

  ‘What for?’ asked Mrs Hardcastle.

  ‘Just to see whether you like it,’ said Ms Smith.

  Luckily a Mrs Jones was away for a few days and had given permission for her bungalow to be shown to visitors.

  They entered and were immediately enveloped in a stagnant warmth.

  ‘Isn’t it lovely and warm?’ said Ms Smith to Mrs Hardcastle. ‘Not at all like Sebastopol Villas.’

  Indeed, the cold of Sebastopol Villas sometimes seemed not just the absence of warmth, but something positive, that emanated from the walls. Surely anyone would want to live somewhere warmer.

  Mrs Jones had a collection of china horses – hundreds and hundreds of them. She also had vases with bright red and blue plastic flowers. In the sitting room was a large television.

  ‘It’s very cosy, isn’t it?’ said Ms Smith enthusiastically. ‘I could live here myself.’

  The visit over, Ms Smith drove Mrs Hardcastle back to the hospital.

  ‘It was lovely, wasn’t it?’ said Ms Smith. ‘You’d be much better off there – or somewhere like it – don’t you think?’

  Actually, Mrs Hardcastle couldn’t go to Fallowfields, because it was full and there was a long waiting list to get in. She would have to go to somewhere like Senior Court, a much larger establishment, where the silence of the deathbed was punctuated only by the screams of the demented. The staff there spent most of their day locked in the office, drinking coffee and chain-smoking. But at least it was warm, better th
an Sebastopol Villas.

  ‘No, I’d like to go home,’ said Mrs Hardcastle.

  Whenever old people were particularly obstinate, Ms Smith adopted a very sweet tone, in which reason and compassion fought for the upper hand.

  ‘You don’t have to decide now,’ she said. ‘You can think about it.’

  Mrs Hardcastle didn’t think about it, nor did she have to, because she already knew what she wanted. She wanted to go home.

  Ms Smith visited her two or three times a week to find out if she had given any thought to Fallowfields, and had changed her mind. Every time she came, she used the same arguments: Sebastopol Villas were cold and damp, she was isolated and vulnerable there, Fallowfields was warm and there would be company for her there. But Mrs Hardcastle still wanted to go home.

  The matter became urgent, however. Ms Smith came one day and sat next to her instead of bending over her, as she had done on her previous visits.

  ‘The service is being reconfigured,’ she said to Mrs Hardcastle.

  Mrs Hardcastle showed no sign of having understood.

  ‘The service is being reconfigured,’ repeated Ms Smith. ‘That means this ward is closing. You’ll have to go somewhere else.’

  ‘So I can go home?’ said Mrs Hardcastle.

  ‘Well not exactly,’ said Ms Smith. ‘The services are being reconfigured to make them more efficient. We have to consider best practice and value for money. And it’s been decided that this ward represents neither, so it’s closing in a week’s time. A new Chief Executive’s been appointed, and you know how a new broom sweeps clean.’

  Old age being a time of reduced horizons, Mrs Hardcastle did not appear to take much interest in what Ms Smith said.

  ‘That means we’ll have to think of somewhere for you to go,’ said Ms Smith. ‘And quickly.’

  ‘I’d like to go home.’

  There was nothing for it, then: Ms Smith had hoped to avoid having to take this step, but now she saw that it was unavoidable.

  ‘You’ll have to come with me, Ivy. I’ll have to show you.’

  She took Mrs Hardcastle once more in her car, but this time to Sebastopol Villas – or to what had until recently been Sebastopol Villas. It was now a pile of rubble, having been demolished.

  ‘There was a compulsory purchase order on Sebastopol Villas because they were unfit for human habitation. Now do you see why we have to find somewhere else for you to go?’

  But Mrs Hardcastle wasn’t listening to Ms Smith. She was listening to someone else.

  ‘Buzz off, ’ardcastle, and take yer effing roses with yer.’

  5 - Only a Piece of Paper

  Mr Montagu, the rich widower and businessman, who was in his late middle age, had a large part of his bowel cut out because of cancer. Until the discovery of the tumour he had never had a day’s illness, but he bore the indignities of hospital and surgery with fortitude, even though he was more used to giving orders than to receiving them.

  He was unassuming and undemanding in the hospital, making no complaint if a meal was not to his liking, or if the surgeon came on his rounds later than expected. He was not fractious, as many in his situation were. He did not protest against fate by persecuting those who were trying to rescue him from it.

  The operation was a success and his recover uneventful. Still, the operation weakened him and it was a few days before he was allowed home. During these days he displayed none of that self-important impatience that men accustomed to successful activity often show in the face of natural processes, such as healing, that are refractory to their wills. He was obviously wiser than other men of his type.

  He was grateful for everything that was done for him, though in a polite and detached way. When it was time for him to leave the hospital, he bought a large box of chocolates of the best quality for the nurses, though he was unsure whether they would be able to distinguish them from less expensive varieties. He presented them to Sister Lee, the Chinese nurse in charge of all the others. She thanked him and told him that he need not have bothered: it had been a pleasure to look after him.

  He went home to his elegant flat in a quietly fashionable eighteenth-century square. By now he had come to accept his loneliness and even, when too long in the presence of others, to like it. Other people were inclined to noise and Mr Montagu prized silence, all the more so after his operation. Although he was told that, as far as the surgeon was able to discern, all his cancer had been removed, it was impossible for Mr Montagu not to feel that he had been touch by, if not definitively marked out for, death. In the circumstances, extraneous and unnecessary noise was burdensome and even – though Mr Montagu had long ceased to follow the religion of his forefathers – sacrilegious.

  About two weeks after his return home, while his cleaning lady was fussing over things that were already clean (for a widower of his age and orderly habits did not generate much to do), he heard the post arrive through his letter box. There was only one letter, from the hospital, but it was not official. It was hand written.

  Dear Mr Montagu (it went),

  When you are in the ward I see that you are a very nice gentleman. You are very kind and smiling, even when in pain. You are also handsome.

  Therefore I would like very much to meet you again, as nowadays there are not very nice gentlemen to meet. Here is my address and telephone number. Thank you for calling/writing to me.

  Yours very sincerely,

  Victoria Lee (Miss)

  Ward sister of your ward

  Mr Montagu was astonished. In fact, he had to sit down to read it a second time. Was it a declaration of love from someone from an alien land who did not know how these things were done here? Mr Montagu, though well-disposed towards her, had scarcely noticed Sister Lee. She was neither beautiful nor ugly, she was thin as Chinese working women tended to be, a presence rather than a personality, who seemed to value efficiency for its own sake rather than because it brought comfort to the patients. He would have guessed that she thought that emotion of any kind was an impediment to the smooth running of the ward. He assumed – or rather, he would have assumed if he had thought about it – that for her he was just another patient, an animated statistic at best, an interruption to routine at worst, rather than a living, breathing man. Certainly, he had done everything in his power not to stand out from the other patients, not to magnify his importance or claim that his needs or wishes should be attended to first, before those of everyone else. Now it appeared that he had succeeded so well in maintaining his modesty of demeanour that he had stood out because of it. But all the same, he had done nothing, absolutely nothing, to encourage Sister Lee to develop an affection for him, on that point his conscience was quite clear.

  How, if at all, should he answer? To answer would be to encourage; but not to answer would be cold-hearted or cruel. Although time and thought would not necessarily resolve the dilemma, experience had taught Mr Montague not to rush into replies to disturbing letters. Right solutions came not by a process of rational thought, but by a process of precipitation in the mind. He would sleep on it.

  The next day, having other matters to attend to, Sister Lee disappeared from his thoughts. Caring for his investments, now that he was retired and dependent upon their yield, was not only good mental exercise but essential to his well-being. By no means avaricious, and not desirous of becoming the biggest fish in whatever pool he found himself (a disease of youth from which he had long been cured), he nevertheless had the businessman’s sense that unless he was becoming richer he was becoming poorer. Merely to maintain a fortune was therefore not enough.

  On the following day, however, another letter from the hospital arrived. Mr Montagu knew at once that it would be from Sister Lee, and it was.

  Dear Mr Montagu,

  I hope you are not suffering from any complications so you cannot write. I am waiting very hopefully for your answer because you are such a polite man.

  Yours very sincerely,

  Victoria Lee (Miss)

&nb
sp; Mr Montagu smiled. There was a certain naïve, bittersweet charm to the letters that disarmed him and caused a faint warmth to course through his veins. Surely only a very sad person would expose herself in this way to contumacious and humiliating rejection? Then a dark and unpleasant thought crossed his mind: suppose she were an unscrupulous gold-digger? How stupid he would look if, at his age, and with his knowledge of the world, he should fall prey to the machinations of a common schemer? One who, moreover, was not a raging beauty over whom any man might lose his head? Mr Montagu was not particularly sensitive to the opinion of others, but like most men he did not want to be a laughing stock. What would his children think?

  But no, he thought again, she could not be a schemer, for she could know nothing of his circumstances. True, his treatment in the hospital had been very expensive, she must have known that, but he might merely have been well-insured through his work, like most of the patients. She would have known that he was a widower – that much would have been clear from the hospital notes – but that she chose a widower rather than a married man was really rather to her credit than otherwise.

  Why not contact her? What harm could come of it and what, really, had he to lose? If he were honest, he had accommodated himself to being alone from necessity, not from choice or taste for his own company: in other words, he had made the best of a bad situation. He had interests to absorb him, true enough: he tended his bonsai trees, for example, and read voraciously, particularly on historical subjects. He had even become a collector, in a small way, of old, elaborately engraved share certificates, particularly of the Ottoman Empire, which were a window on the past, or at least on a part of the past. But all the interests in the world did not equal one human contact, and while his business career had left him with many acquaintances, even friendly acquaintances, it had left him with few friends: for in the business world, people were friendly in proportion to their usefulness, and the fact is that Mr Montagu, now quietly living on his investments, was not useful any more. In addition, people in business were impatient of those who had been very ill and like to die, for mortal illness did not enter their calculations and, insofar as it raised disturbing questions about the real worth of their ambitions, was cast out of their minds by a mental Iron Curtain. They were not so much fully rational as very calculating, and superstitious about illness, as if all types of illness were contagious. They wanted nothing more than necessary to do with the ill, or even with the cured.