‘Anyway, he was impressive, a catch. My whole world was medicine and this guy was on his way to the top of it. Older, more experienced, a known name, and doing the job for real – you spend so much time worrying about whether you’re going to make it to that part, and whether you’ll be able to handle it if you do, that someone already there commands great respect. So for him to show an interest in me felt all the more complimentary. And with him being from this big Edinburgh medical family, I thought I was really arriving. I wasn’t just looking at a career in medicine here, I was chosen now, I was on my way to the inside. Taken to the right drinks parties, the right social gatherings, the right “at homes”. Regular dinners at the Ponsonbys’ in Morningside, first-name terms with all the major medical bods before I was even in my first house job.
‘We went out for almost two years, and got married a fortnight after my graduation; time for a brief honeymoon before my first Junior House Officer post. We bought a flat in Bruntsfield. It’s near the RVI, near the university, and there and Marchmont are where every bloody junior doctor in the city lives. The ones who consider themselves alternative live in Stockbridge along with the lawyers and coke dealers.
‘There were two more doctors in our close. You’d bump into colleagues in the supermarket, see them in the street, the restaurants, all a happy wee medical community. There’s a couple of hateful wine bars up that way. I doubt you’d ever have call or reason to go into them, but if you do and you feel ill – which is likely – don’t ask if there’s a doctor in the house, as you’ll get crushed to death in the ensuing stampede.’
Sarah laughed bitterly to herself.
‘You all live around there as students. You move into a nicer street once you’re qualified. And then once you’re a consultant you move half a mile down the hill to Morningside.’
She shook her head and gulped at her drink.
‘Anyway, married life didn’t get off to a great start, as I was working an illegal two-in-five rota for the first six months and a one-in-three the next. Combine that with Jeremy’s one-in-four and you’re lucky if there’s two nights of any week that you’re both sleeping in the same bed. Plus Jeremy was constantly studying for the two-part Royal College of Physicians membership exam by this time, which took precedence over spending “quality time” with his new wife. We had all our lives to spend together, for God’s sake, whereas the MRCP was urgent.’
‘Is there a time limit on it, then?’ Parlabane asked, pulling his other foot up on to the bench and crossing his other leg beneath his knee.
‘There’s a limit to the number of attempts you can make to get each part, usually four. They hit you for between two and three hundred quid for each attempt, and there are those malcontents who would suggest that there might be a conflict of interest generated by the fact that first-time passes don’t make the Colleges as much money, but I digress. The attempt limit wasn’t the reason for Jeremy’s urgency. It’s a race, you see.’
Parlabane clearly didn’t.
‘When you’re in school you can get As and Bs, even percentages; you can know you got a higher mark than the rest of the class. In university medicine you can get merit certificates, passes with commendation, passes with distinction, even prizes, again letting you know how you shape up against the competition. Once you’re into the post-graduate world – things like the MRCP, or the FRCA, or the FRCS – they only tell you whether you passed or failed. You don’t find out whether you passed with fifty-one percent or ninety-one percent, and that drives them bloody nuts. So the only way to carryon the academic pee-the-highest, mine’s-bigger-than-yours contest is to get the qualifications in the fastest possible time.’
‘But don’t you need a certain amount of – how would you put it – clinical experience to pass these things?’
Sarah laughed. ‘One of the first things you learn at medical school, Jack, is that the exams never ever test anything you will encounter in a practical context. It’s always the periphery, the obscurities that you get asked about. And the result is that the system churns out junior doctors who have paid bugger-all attention to the meat and two veg medicine they will find themselves up to their necks in from day one. The favoured medical cliché – and we love our clichés – is that when they hear hooves they look for zebras instead of horses. However, post-grad, the exams are broken up into parts: two for medicine, three for anaesthetics . . .’
‘Why does it have three?’
‘It’s the new kid on the block, with a chip on its shoulder and a point to prove. It needs to have one more part than the others to demonstrate that it’s even more fartily academic than they are. Anyway, you don’t sit all the parts then find out you’ve passed or failed – you need to pass the first before you progress to studying for the second, and so on. The idea, the theory, is that you are indeed supposed to have that parallel degree of clinical experience you mentioned. What’s the point of a doctor who got the MRCP in record time but can’t spot a sickie if they’re dying in front of him?’
‘Not much, I would have thought, but I am a lay person.’
‘Indeed you are. The theory is fine. The problem is that in practice, the higher echelons are filled with guys like Jeremy a few years down the line; people who are impressed with that sort of obsessive competitiveness, and therefore reward and consequently encourage it. So the theory gets forgotten, and no one cares whether you’re a dreadful doctor, as long as you whizzed through the Membership or the Fellowship or whatever. Reciprocally, no-one cares whether you’re a great doctor if you struggle with the exams.’
‘So did Jeremy win his race?’
‘Of course. Passed both parts first time. Made his family very proud.’
‘But not you.’
‘We had a fight the night he found out he passed part two. He sensed I wasn’t knocking him over with congratulations and I told him why. I said I couldn’t bring myself to celebrate his achievement unreservedly because I felt it had come at a price. He had paid me so little attention for months because of this exam and I was suddenly supposed to put on my party frock and be full of the joys now that he was ready to come out and play again. I refused to come out that night, sent him off to the pub on his own to celebrate with his churns, whom he presumably told I was on-call.
‘I was supposed to have understood the importance of his endeavours and been the supportive wife during those months, then looked on in silent, glowing joy at my wonderful husband’s achievement, secretly content with my own, small part in it. And I soon realised that was the template.
‘He never forgave me for that night. I think it was the first time he hadn’t got his way, got exactly what he wanted; the first time life hadn’t served up what he’d ordered. Maybe that’s what triggered the self-destructive streak. I’ve often wanted to ask the Ponsonbys whether Jeremy held his breath as a child when he didn’t get his own way. Because although his behaviour was self-destructive, he did it to hurt me.
‘The gambling started about then. I used to think it wasn’t related, but I came to realise that he was already looking for a way to hurt himself and the gambling just announced itself as a timely candidate. He went to Musselburgh races one day with “the lads”, his first time backing horses in his life, got steadily drunk and had a disastrously successful afternoon.’
‘Oh dear. How bad?’
‘About four hundred quid. He went there with sixty.’
‘Ouch.’
‘He had started off putting on a tenner on the first race, on the nose, won at fives. Couple of twenty-quid losers, then a twenty-quid winner at eleven to four. By the last race he was by all accounts so arseholed he had to get someone more sober to place his bet because the bookie offering the best odds was too scrupulous and pitying to accept a hundred-pound stake from someone in Jeremy’s condition.’
Parlabane reeled. ‘Pissed or not, a hundred quid is a lot for a first-timer who started the day on a tenner a throw.’
‘Well, don’t ask me what was going thro
ugh his mind. I only married him. Although I suspect it was the risk, because that was what hooked him. Jeremy’s life had been such a smooth journey of measured order and control; he had known what to expect in everything he had done. He worked conscientiously for exams but unlike me, he never worried he might fail. He knew what was required, and assessing how much work he had got through, knew what mark he was likely to get.
‘And on the practical side, medicine was all cause and effect, problem and solution; percentage chance of survival, percentage chance of complication, patient not for ressus . . . The sense of risk, of a lack of control, would terrify most medics; might even have terrified Jeremy during a less nihilistic phase. Instead it electrified him. He could have lost the hundred quid on that race and it wouldn’t have made a tiny bit of difference, I suspect. The rush was enough. The seed was planted.’
FOURTEEN
Parlabane shifted his position and sat forward, placing his empty glass on the table.
‘So why did he want to hurt you?’ he asked.
Sarah paused, running a hand through her hair and grimacing, thinking uncomfortable thoughts.
‘Things between us . . . deteriorated. Slowly at first, a few peaks and troughs, but . . . it was definitely downhill. What confuses it all is that my disillusion with medicine stems from the same period. I don’t know whether my disillusionment with medicine accelerated my disillusionment with Jeremy or whether my disillusionment with him made me less tolerant of what I was coming up against in my job, but they certainly had a symbiotic relationship in my mind.
‘I had built him up as a figurehead for all of it when I was younger, and . . . I don’t know. My attitude to the whole thing was changing and he didn’t have a problem with any of it. He never questioned anything in medicine, never thought that how it was wasn’t necessarily how it should be.’
‘What happened to you? What changed your attitude?’
‘Well, after the phony war of medical school, actually working was a rude awakening. You’re prepared for the work, the exhaustion, the fear, the mistakes . . . it’s not that you’re not expecting a hellish time. The first six months as a JHO passes in a sleepless haze of bewilderment and sheer terror. The next six you’re used to it, fed-up and vaguely resentful. But by the time you’re into your SHO job, your eyes are open that bit wider. You’re less concerned about what is happening to you and more able to notice what’s happening round about you.
‘And to cut a very long story short I didn’t like what I saw. I wasn’t naive enough to think that I would be saving lives and curing people’s ills, but I wasn’t prepared for the fact that nothing we did seemed to have much effect. I got the impression that nobody ever got better. There was a soul-destroying feeling of banging my head against a brick wall.
‘Looking back, I’ll admit that this was naive. I should have been ready for the futility as much as I had been ready for all the other pains and torments. Most people were, and they could deal with it. Some developed a cheerful resilience that I admire unconditionally. Sure, it got them down, but unlike me they didn’t let it grind them down. The word futility had no meaning for them. They knew there was bugger all they could do half the time, but they weren’t in the business of lasting solutions. They were in the business of alleviating suffering, slowing effects, combating symptoms. They knew every battle was a losing battle but they could go out there and fight it every day with a commitment I just couldn’t give.’
‘But presumably Jeremy didn’t number among these medical guerrillas,’ Parlabane said.
‘Not quite. I said some dealt with it with heart and resilience. More time in their company and I might have picked up the example and learnt their admirable attitude. The problem was the other way people dealt with it.’
‘Total detachment?’
‘Worse. I could have dealt with total detachment. You have to have fucking feelings before detachment becomes a self-defence mechanism. In a nutshell, when I saw a patient with some unusual, bewildering, painful and possibly fatal condition, I just saw a suffering human being that I couldn’t do much to help, and it depressed me. Jeremy, and many like him, coming across the same patient, would be bloody delighted. They wouldn’t be looking at a person there at all. They’d be looking at a very interesting case. A collection of symptoms. An intriguing study. They’d be looking at a paper in the British Medical Journal with their name and qualifications at the top of it. And if they were really lucky they might get to name what was wrong with the poor bastard after themselves. “Ponsonby’s syndrome: a searing, stinging sensation in the rectal region. Other symptoms: sudden disappearance of all your money.”
‘People like Jeremy – channelled into medicine from day one without being allowed a glimpse of the possibilities in the wider world – they saw medicine as merely a place to excel. They had never considered the patients before they went into the job, why would they now that they were there?
Anyway, my general dischuffment with the subject wasn’t quite the ideal accompaniment to having my own crack at the MRCP, and it was little surprise when I failed part one twice. It was about a week after I got the letter informing me I’d failed again that Jeremy suggested, basically, that as I wasn’t cut out to shine in hospital medicine, I should consider a move into GP training and think about bearing him some children. It wasn’t quite as blunt as that, but it was close. I was in a vulnerable and fragile condition at this point, so I just took it along with the other blows, not really thinking about it properly. Then we went to the Ponsonbys’ for Sunday dinner and the same suggestion was made by his parents over the fucking roast lamb and mint sauce.’
Parlabane almost choked on his drink.
‘What?’
Sarah nodded.
‘The message was simple,’ she said. ‘If you marry a Ponsonby, either you’ve got to shine dazzlingly in the field, or squeeze out some sprogs to keep the line going and play a quiet, supporting role while he maintains the glorious family reputation. I just said excuse me, walked out and drove home.
‘I came to realise that me bearing him kids had always been in Jeremy’s plans, even though he hadn’t talked much about it. It was as if he had been expecting me to screw up in medicine, patiently tolerating this silly pursuit of ambition until I inevitably came to accept reality, then offering me a more appropriate role. So I wondered how far back it went: was I singled out as a good candidate to mother his kids – and therefore someone not likely to go far in medicine – way back when I was in fourth year?’
‘So I’d imagine domestic bliss did not ensue after that,’ Parlabane offered.
Sarah rolled her eyes. ‘Not exactly. That’s when he started upping the stakes on the horses. He had been gambling steadily since that day at Musselburgh, but nothing too drastic. He knew I didn’t like it, but it wasn’t a big deal. He made it a big deal from then on.
‘He got sucked in deeper and deeper because he was doing it for dangerous reasons. Doing it as a self-indulgence because things were bad at home, doing it to hurt me . . . But what really nailed him was a combination of the rush he got from risking big stakes and the bizarre confidence he had that he would win in the end. Apart from my refusal to get up the stick, everything had gone Jeremy’s way in life, and he thought this must carry through into gambling. If he lost three or four big stakes, he convinced himself that this meant he must be due a really big win. Hundred-pound stakes became two hundred. Two hundred became five hundred.’
‘Jesus.’
And it mounted up over – Christ – a year at least. After a while he was in too deep to be doing it to hurt me any more. He became increasingly secretive about it until one day I tried to pay for the shopping with my Switch card and they wouldn’t take it. I visited the bank the next day and found that he had cleared us out. Not only that, but he had run up tabs that were still outstanding, and the bastard sold the car for cash to pay one off because the bookie was threatening to get heavy.
‘I kicked him out and we agree
d to a divorce. I got the flat, as it was about the only material asset left in the marriage. Ironically, it’s me who’s still living in Southside Doctorsville, while Jeremy had a place in a more interesting area of town.’
‘How did he get that?’
‘His father bought it for him. He was a total mess by the end, and was in fact in such a state that he kind of woke up suddenly and looked in horror at what he had wreaked. He wasn’t a total bastard, you must understand, just a rather fucked-up individual. I’m only telling you the negative stuff because the good times aren’t likely to cast much light on our mystery. He was sorry for what he had done to me, and in fact it was he who first mentioned divorce, saying I deserved better and I should be allowed a clean break from the mess he was in.
‘However, it was only once we had agreed to split that he felt able to reveal the true extent of the debt he was in, and it was terrifying. I’d have had to re-mortgage the flat and he wasn’t going to let me do that even if I had wanted to.
‘I wanted a clean break, but for me that meant I needed to know he would be all right. However, I couldn’t do it alone. We had to tell his family, from whom we had kept it all a secret. They just thought our marital problems were down to me being a dope who wouldn’t do the right thing by her man.
‘He was terrified,’ she said, shaking her head again. ‘More scared of their reaction than of the bookies who were tapping their feet in the background. But there was no way we could sort it out ourselves. In the end he needn’t have worried.’
‘Because his family blamed you.’
‘He shoots, he scores. But I knew they would anyway. In fact I was banking on it. That way they would pull out all the stops to sort their poor son’s life out and get him back on his feet for a new start, free of that dreadful strumpet.’
‘So they made good with the big cheque?’
Quite Ugly One Morning Page 10