Best Practice

by Penny Parkes

  She looked hopefully around the room, carefully allowing her gaze to skim past Cassie Holland, who looked a trifle too keen for a moment in the limelight to be effectual.

  ‘I’ll do it,’ Dan said, as if it were no big deal.

  ‘I hardly think that’s appropriate,’ said Malcolm Bodley pompously, their much maligned and wholly ineffective local councillor, who had been sitting silently at the bar throughout, nursing the same warm bottle of Stella. ‘I don’t think you, or any of the staff from The Practice, can be seen to be objective at this point.’ His voice was a monotone and as charismatic as wilting lettuce.

  ‘Then I’ll do it,’ said Chris, clearly loving the feeling of being part of something bigger than himself. It was an addictive feeling, no doubt, and his military background probably meant that he, like Dan, would always be willing to step up.

  Malcolm shook his head. ‘Of course, if you need me to pick up the baton, to speak for all of you when I say that—’

  ‘I’ll do it,’ said a voice from the back of the room and everyone turned in their seats. ‘Call me invested in how this all plays out.’

  ‘Harry!’ cried Holly, leaping to her feet with as much elegance as a baby elephant.

  ‘Holly! My favourite troublemaker at it again,’ Harry laughed in response. He grinned and pulled her into an avuncular hug.

  ‘I’m so thrilled you’re here,’ Holly said when she’d come up for air. ‘We just decided to get on with it and seize the day. We hadn’t heard from you, so we’re keeping it local, like you said.’

  Harry shrugged guiltily. ‘Well, to be honest, I had fully intended to get on a plane and lick my wounds on a sunny beach somewhere. But it turns out that I hold a grudge. Who knew? So, I don’t think I can truly enjoy my pina coladas until we’ve brought Derek Landers down a peg or two and righted a few wrongs in the process.’ He beamed. ‘It’s somewhat liberating actually, being on the side of the Rebellion. I’ve always been rather Establishment up until now.’

  ‘Brilliant,’ said Taffy happily, shaking him by the hand. ‘Harry Grant’s gone rogue.’

  ‘Can we have call signs and everything?’ Harry asked, clearly swept up in the excitement.

  ‘Like in Star Wars?’ Holly asked drily, the first to catch on to his train of thought.

  ‘Ooh yes,’ said Harry. ‘And if I’m the spokesman for the Rebellion, can I be Rogue Leader?’

  ‘No problem,’ said Grace with an expansive smile; this was obviously better than she’d even hoped for. A proper inside man. ‘But the budget won’t stretch to a Millennium Falcon, okay?’

  Harry tried not to look utterly affronted. ‘I think you mean X-Wing Fighter,’ he muttered under his breath so that only Holly could hear, as he sat down beside her and raised a glass to their joint endeavour.

  ‘So, tell me, what have you got planned?’

  Chapter 25

  Alice fiddled with the rose quartz lanyard around her neck the next morning, before allowing it to fall back into place. There was always a moment of hesitation when she wore something new for the first time; did it truly look as beautiful as the online pictures promised, or indeed make her feel wonderful and complete? Of course, she knew she was looking in all the wrong places for that feeling of acceptance and belonging, but right now something had to be better than nothing.

  With ten minutes until her morning clinic began, and with it a deluge of problems to be negotiated, Alice tapped refresh on her internet browser again; it had become a nervous habit when she felt uncomfortable, to torment herself with Facebook posts of her friends’ wonderful photogenic lives. Far from being soothed, all she felt was a hollow emptiness as she scrolled through holiday photos, engagement photos, wedding photos . . . Didn’t anything bad ever happen to these golden people? Was it even humanly possible to look that glamorous after a transatlantic flight?

  And then, for the first time in a long time, the penny slowly dropped. If she was running her own life through a filter, then what was to stop them doing the same?

  She pulled up her own Facebook page and looked at the posts she’d made: ecstatic pictures with Coco at the training facility (no mention of the heartbreaking decision facing her); gooning faces at the pub with Taffy and Dan (no mention of the harrowing afternoon trying to resuscitate an elderly patient on a house call); and a ‘what shall I wear?’ dilemma when she’d already spent three hours whittling down her choices to the three that looked incredible.

  She shoved the mouse away from her with a force that embodied the sudden wave of bitterness that overcame her. When had all her friendships become as deep as the proverbial puddle, she wondered, clicking through to Skype for a fix of irreverent Tilly-humour to keep her balanced and sane.

  Ten minutes later, despite her Tilly-top-up, Alice knew exactly why her first patient of the day was making her feel quite so uncomfortable. ‘We’ll start with an antibiotic,’ Alice said calmly, ‘but you’ll need to be seen in the foot clinic every day this week for them to change the dressing and keep an eye on things.’ This entire scenario was basically Alice’s worst nightmare and a little glimpse into her future.

  Carol Wainwright sighed. ‘But it was just a blister, Dr Walker. I don’t understand how it can have got so bad so quickly.’

  Alice nodded sympathetically. ‘I know it probably didn’t seem like much at the time, but with diabetes you just can’t afford to ignore your feet. Your annual assessment can only tell us so much, because a lot can change in a year. That’s why we ask you to be vigilant yourselves.’

  Carol looked embarrassed. ‘I do remember reading that somewhere actually, but I didn’t think it applied to me.’

  Alice tilted her head as she evaluated Carol Wainwright. Non-compliance wasn’t something you’d normally expect from the Carols of this world – well-to-do, beautifully turned out, obvious care taken with her appearance . . . ‘How are things generally?’ It was one of those open questions that could lead anywhere and, in Alice’s experience, tended to be the most fruitful. It was so much better than putting her on the spot and asking about the state of her marriage, or how she was coping with redundancy.

  ‘Fine,’ said Carol with a slight wave of her hand. ‘Everything’s fine.’

  ‘Okay then,’ said Alice slowly. ‘Because if there was anything, you are always very welcome to come in and talk to me.’ She smiled. ‘I’m not sure you could say anything I haven’t heard before.’

  Carol forced a smile. ‘So antibiotics and lots of checkups then?’

  Alice nodded, making no effort to move or indeed to start typing the prescription into the computer, her sixth sense still niggling.

  Carol picked up her handbag – Italian leather with a Pucci scarf tied loosely through the handle – and Alice was convinced her hunch was right. Someone who took this much pride in their appearance would never neglect their feet, not with the spectre of diabetic complications hanging in the ether, let alone sandal season in full swing. Not unless there was something else claiming their attention.

  Carol held the bag to her chest as though it were a shield, and her voice, when she spoke, was barely a whisper: ‘I think I might be going mad, Dr Walker.’

  Alice nodded. ‘Okay . . .’

  ‘And not like PMT, or forgetful when I’m tired – I’m talking batshit crazy.’

  ‘Ah, the technical term,’ said Alice gently. ‘Are you aware of any particular triggers?’

  Carol looked up at her through her eyelashes, as though fully expecting Alice to mock her. ‘Crisps, cereal, apples, muesli bars . . . Anything crunchy really.’ She paused and managed a small smile. ‘I’m not making much sense, am I? But it’s become so distracting, I can barely think about anything else. It’s just the sound of someone eating, chewing, masticating—’ Carol was clearly working herself up and Alice laid a soothing hand on her arm.

  ‘Just eating sounds?’ she queried. ‘What about breathing?’

  ‘God, yes!’ said Carol with feeling. ‘All night long – my husban
d is breathing like a fucking walrus. It’s a wonder I haven’t smothered him in his sleep.’ She stopped. ‘It’s not snoring though, you understand, just normal breathing. But it never used to be so, well, loud.’

  ‘Has it been keeping you awake at night then?’ Alice asked, trying to get some measure of how badly Carol was affected.

  Carol nodded, pausing for a moment. ‘And I’ve stopped going out for dinner, going on the train – anywhere people might be eating and I can’t get away.’ She looked aghast at having to share what she clearly felt was bonkers behaviour. After all, she’d come in with nothing more than an angry inflamed blister that refused to heal and prevented her wearing high heels.

  ‘Well, the good news is, you’re not going mad,’ Alice said gently. ‘What you’re describing is a condition called misophonia. We will all experience it to some degree in our lifetime. For some people, it’s that nails-on-a-blackboard-type situation, but for a few it can develop to include all sorts of sounds. And,’ she said, gauging Carol’s reaction, ‘for some it’s not just about disgust, but actual rage. Does that sound familiar to you?’

  Carol nodded; the red flush mottling her chest was inching its way up her neck. ‘Fury,’ she said quietly. ‘As though they’re being deliberately loud just to piss me off.’

  ‘Do you think the eating sounds and the breathing are louder than normal, or is it possible that you’re aware of it now, so you might be expecting it?’

  Carol fiddled with her handbag. ‘I downloaded an app. It’s a decibel meter. I was beyond surprised, to be honest, when even the bloody crisps hardly registered. That’s when I decided I must be losing the plot.’

  ‘I’d like to consider a few options for this. We can think about using some TRT, that’s Tinnitus Retraining Therapy – basically it’s designed to improve your tolerance of certain noises, maybe even with a little positive deconditioning. But since it’s so important that we get you balanced and focused, so you can maintain your at-home diabetes care, I’d like to suggest we also try a course of mild antidepressants.’ She held up her hand before Carol could protest. ‘Although I’m not suggesting you’re depressed, just that they have been shown to help. We can also talk about white noise, just in the background to decrease the contrast – if you hop online there’s all sorts of behind-the-ear noise generators; it’s trial and error mainly.’

  Carol was breathing normally again now – the panicked shallow breaths had relaxed. ‘It has to be worth a try.’

  ‘And cut yourself some slack,’ Alice suggested. ‘Have supper in front of the TV. Maybe find a show you really enjoy so you start looking forward to mealtimes again?’

  Carol’s face broke into a smile, a relieved smile. ‘Are you basically saying it’s doctor’s orders to eat on the sofa watching Gilmore Girls?’

  Alice grinned and pulled open her drawer to find one of the old-school green prescription pads and scribbled a note to that effect. ‘Take three times a day or as necessary,’ she said. ‘And I want to see that foot again in three days. And every day with the foot clinic, yes?’

  Carol nodded, her body language totally different now.

  Alice stood up. ‘This whole diabetes thing is enough of a bastard without adding sore feet and miserable mealtimes to the mix.’

  Carol caught Alice by surprise as she pulled her into a spontaneous hug, untangling her hair from Alice’s necklace.

  ‘Beautiful lanyard, Dr Walker,’ she said as she left.

  Alice allowed the quartz stones to run through her fingers and smiled. For the first time in ages, one of her pick-me-up purchases had actually served its purpose. In this case, to remind Alice that whatever might be falling apart in her personal life, when it came to her job, her instincts were still second to none.

  Back in the doctors’ lounge after morning surgery, Alice was still on a high. Misophonia ticked all her boxes for the quirky and unusual. She filled up her mug with hot water, dunking an Earl Grey tea bag to give just a hint of flavour.

  ‘For God’s sake,’ said Dan, as she tossed it into the bin, ‘at least make a decent cuppa with it.’ His voice was oddly irritable and Alice frowned for a moment, confused, until she followed his gaze and saw Grace. Grace looking hungover and tousled. Obviously the plotting session in the pub last night had run on much later after Alice had left.

  Alice sipped at her mug and went to sit beside her. ‘Morning. Should we all be whispering today?’

  Grace managed a smile. ‘It wouldn’t be the worst idea. I thought you weren’t supposed to get a headache with champagne. Chris’s idea, so it’s all his fault, really.’ She grimaced, recognising how spoiled that sounded. ‘First World problems, eh?’

  Alice laughed, even as the sound made Grace wince. ‘That Chris Virtue knows how to spoil a lady – first it was fancy ballrooms and fine dining, now it’s late-night champagne at the pub. I’m liking his style. Did you have a good time? With Chris, I mean.’ Alice was aware that she was fishing, but couldn’t resist. After all, she’d been gradually baring her soul to Grace for weeks now; it was high time the current flowed both ways.

  ‘Chris was, well, I guess you could call him the perfect gentleman,’ Grace said quietly.

  ‘Not too perfect, I hope,’ Alice teased her.

  Grace just blushed prettily and flicked her eyes across the room to make sure nobody was listening. ‘Not too perfect. Just lovely actually. Even if—’ She broke off abruptly. ‘Never mind. And actually, the champagne gave me one or two ideas about how we might be able to raise a little extra money ourselves . . .’

  ‘Grace,’ Alice chided, ‘I hate to tell you, but this wasn’t a busman’s holiday, it was a date. A second date, really.’

  Grace shrugged. ‘So I mixed a little business with a little pleasure. It was easier that way; otherwise it might have been a little overwhelming, to be honest. I hadn’t realised the dinner the other night was actually my first date since—’

  ‘So it was a date then,’ Dan interrupted, having somehow made his way silently across the room. ‘And is Chris the model of Virtue – or is he just another pilot, going for the prettiest girl in every room?’

  Alice froze, unused to Dan being anything other than friendly and professional. She always forgot about his stint as an Army medic and guessed he must have come across one or two pilots in his time, who merely had to click their fingers and have all the girls come running.

  Grace said nothing, her confusion evident in the hurt expression on her face. Alice shook her head; it didn’t seem fair for Dan to rain on Grace’s parade, particularly since he’d had all the time in the world to make a move himself. Sour grapes because of Chris Virtue seemed a little petty and immature to her.

  ‘I’d take the compliment, if I were you, Grace. Dan here obviously thinks you’re the prettiest girl in this room.’

  Grace’s smile was forced and tight as she stood up to leave. ‘I think I need some paracetamol,’ she said.

  Alice turned to watch her leave. ‘Jesus, Dan, what was that all about? Do you know something about Chris Virtue that we don’t?’

  Dan just shrugged and left the room, leaving Alice feeling as though she were back in the Sixth Form Common Room.

  ‘So,’ said Maggie into the uncomfortable silence, ‘I gather you’ve been having all the interesting cases this morning? Misophonia? That’s a new one on me.’ As their resident pharmacist, Maggie had the reputation of being widely read and well informed on almost every medical topic. That and having the cleanest, most sanitised space in the building. ‘Is that why I want to club people who eat with their mouth open?’

  Alice sat down beside Maggie, the tension between Dan and Grace leaving her oddly rattled and grateful for the distraction. She shook her head. ‘Nah. I think that’s just because it’s plain rude and disgusting, don’t you?’ She was almost pleased to find that she wasn’t the only one checking herself against the parameters for the condition. It was all too easy to become a hypochondriac in this profession. Only last wee
k, she’d been adamant that she had an emerging case of argyria, the so-called ‘Blue Man’ disease, before she’d discovered the leaking blue ink pen in her pocket.

  ‘Still,’ said Maggie, as she wiped down the table top in front of her with one of her omnipresent antibacterial wipes, ‘it must be nice to diagnose something like that, even if it’s not what she came in for. I suppose only time will tell if those antidepressants help?’

  Alice nodded. Truth be told, she was convinced the TRT and the white noise were a better bet, but Carol was already showing a few symptoms of mild depression anyway, so there was no harm in trying a multi-faceted approach.

  She took one of Maggie’s proffered oatmeal and raisin cookies with a smile. This morning had been just the timely reminder she’d needed as to why she’d chosen general practice over a speciality. Even though it had been driving her crazy of late just to feel as if she were a glorified triage and traffic director, with her only responsibility being to point patients towards the consultant that could actually help them, today had reminded her of the truth. Being a GP was actually a greater challenge – to see the whole person, mind and body, from cradle to grave. It was a responsibility and an honour, she decided, and one that shouldn’t be taken lightly or dismissed, whatever some of her med school friends might imply.

  She looped the rose quartz lanyard around her fingers again and sat back in her seat, while Maggie filled her in on all the latest gossip and the nurses played a loud and filthy rendition of snap in the corner, with what appeared to be a selection of gruesome Polaroids of skin conditions that had passed through their clinic.

  Being a GP, getting to know her patients’ foibles and idiosyncrasies, suddenly felt like the greatest and most fascinating challenge she could have. And maybe, who knew, maybe she might get to know herself a little in the process.

  After all, who knew that an oatmeal and raisin cookie could actually taste this good?