by Mairi Chong
When Fraser himself arrived at the pharmacy that morning, he had managed to push the previous day’s unpleasant interview to the back of his mind. He moved through the shop as always, hanging his suit jacket at the back and replacing it with his white coat. Only then, on turning and seeing standing outside the shop, an official-looking gentleman who he had not noticed before, did his panic return. They had come. He had been found out. Oh God, what a fool he had been to think he might get away with it.
7
Cathy’s heart sank when she heard a knock on her door after her morning surgery. The door opened and a face appeared.
‘Linda,’ Cathy said, and paused, hating herself for being so cold.
‘Sorry to be a pest,’ Linda said, ‘I wondered if I might grab you before you went out.’
‘It’ll have to be quick,’ Cathy said, unable to bring herself to look at the girl and instead concentrating on her computer screen. ‘I have four house visits to get done before the palliative care meeting and lunch isn’t happening today for sure.’
Since returning to work, Cathy had found herself becoming more and more irritated by Linda’s tentative approaches. She knew that the girl was trying to be friendly and Cathy was embarrassed by her own inner turmoil. Linda had done nothing wrong, Cathy told herself. It was simply that circumstances had made their professional relationship awkward. Cathy was a very proud person and it had pained her to admit weakness in front of a more junior member of staff, especially one whom she had personally trained. Cathy recalled Linda’s faltering words as she left for her three month-long break, her assurances that she would take care of things for Cathy and look after her patients as best she could. At the time, she had been too upset to respond. James and Mark had all but frogmarched her to the door and told her to take the time it took to get well before returning.
The breakdown had come from nowhere it seemed. She had cruised through medical-school without much difficulty. She was far from confident at that stage, but self-assured enough to trust in her knowledge and be able to accept her mistakes when she made them following her studies as a junior doctor. When it had all changed, she didn’t know. She had been the life and soul during her hospital days, moving from department to department and enjoying the variety. Even her first year as a GP principal had been smooth.
Since the time off, however, Cathy had painstaking run through the months and years before her mental crash, and had seen that James had protected her to some degree, shielding her from the full-workload in her initial year as a partner. The business side of the practice had been of no interest to Cathy in the beginning. She had trained to be a doctor, not a manager. James presumably saw this, and he and Mark had gradually introduced her to the commercial factors, the staff direction and so on, without expecting too much. Looking back, they had been so thoughtful really.
And then she had begun to take on more. Feeling optimistic about her position, Cathy had agreed to mentoring some of the final-year medical students and then, the year before she became unwell, she had signed up as a retainer-GP trainer, and so had received Linda as her first trainee. The retainer scheme was mainly for returning GPs following time off for pregnancy. Linda had taken a full year away from medicine and had come back somewhat rusty. She had required a good deal of support, her knowledge returning fairly fast with Cathy’s supervision, but her self-assurance taking longer. Linda wasn’t to blame for the stress in Cathy’s life, but she supposed looking back that it hadn’t much helped.
At the time, Cathy had been unaware of her own mood alteration. Linda had been one of the first probably to spot it, and this too annoyed Cathy. It had been during a tutorial. Cathy had been teaching the girl about the Implanon contraceptive device, explaining the pros and cons of it, and even going through the insertion technique with diagrams. She must have lost her train of thought though, and only became suddenly very aware of Linda’s worried eyes upon her. ‘Are you alright, Dr Moreland?’ Cathy had stared for how long, she didn’t know. Then without a word, she had risen and run from the room to vomit in the staff toilets. This pattern had continued over the coming weeks. Her sleep had been dramatically altered too, with Cathy waking in a cold sweat, panting and terrified. In the morning, having slept fitfully, she had known that it was a simple panic attack, but at the time she thought her world was ending. The lack of sleep took its toll. Her work had admittedly suffered. There had been no reason, that was the upsetting thing. There was no trigger to start it off.
On those days after work, having crawled through a long day, sleep-deprived and emotional, but desperate not to show it, she had found herself counting the hours until she climbed the stairs of her small cottage and forced herself to sleep. The nightmares were appalling. It almost made the act of sleep futile. She craved rest more than anything, but dreaded it too. She had drunk more over the preceding months. She didn’t count the units, but it was far in excess.
And then, she had arrived at work on the final morning. Brenda the practice manager, accompanied by James had entered her room and had closed the door. No more, they had said. She was to leave that morning and get help. She had argued and told them that she was fine, that she had patients to see. They were waiting for her. Mark had then come into the room. She could hear his words now.
‘You stink of it, Cathy. How you expect us to allow you in front of patients is a bloody joke. You shouldn’t have even driven this morning. You must be over the limit. There have been complaints. Your language has been bad, to say the least so God knows what you’ve said to the patients. Get out before you say anything more and get yourself sorted, for Christ sake. It’s a bloody joke, coming in like this.’
She had left immediately, returning the following day sober and full of remorse, but they wouldn’t have it. That was when Linda arrived at her door offering to cover her sessions until she was ready to return, presumably having been already primed. James and Mark had given her no option in the end.
And after that day, her life had changed forever. Up until then, she had been able to hide for the most part her inner turmoil. She had concealed the racing thoughts and the music which played constantly in her head, she had masked the erratic moods as best she could. She had failed her patients. Even they must have seen the change in her, the agitation, the lack of patience. It was this that pained her more than anything. When faced with losing it all, she had, of course, gone to speak to someone. The psychiatrist had told her what she already knew herself. But to hear the words ‘bipolar disorder’ voiced aloud, had all but destroyed her.
She had taken the time out and had rebuilt her strength, although it had been hard to conform to the antipsychotics initially. After a holiday alone up north however, she had come back feeling more like herself. But still, she was terrified of losing what she loved. Her career was everything to her and having nearly lost this, she knew that her fitness to practice was still precariously balanced. Occupational health would continue to assess her, and would do so over the coming months, checking in that she was stable. She was to continue seeing her consultant psychiatrist for the time being, that was one of the stipulations they had made. He was cautiously optimistic about her return to work, given that she had improved so fast, but with this came the caveat that she was to avoid undue excitement or stress. So, she had returned to the practice full of vigour, but gone was any ease of friendship with Linda anyway. The girl stood awkwardly now.
‘So,’ Cathy said. ‘What’s up?’
Linda settled herself on a chair and fidgeted with her hands. Cathy waited without speaking. Something was obviously upsetting the girl.
‘I know you’re not my supervisor anymore. I’m an independent GP. I just thought it should be you I told, though.’ Linda paused and shifted again in her seat.
The interview lasted short of five minutes. Following their conversation, Cathy marched through to Brenda’s office and without knocking, went in. Brenda looked up in surprise.
‘Cathy? Whatever’s wrong?’
<
br /> Cathy paced the small room. ‘Brenda you are going to have to do a bit of clearing up. Linda has made an utter mess of something. A major mistake. It will need a good deal of tact from you and the partners.’
‘What on earth’s happened?’ Brenda asked again.
‘The flu clinics,’ Cathy said. ‘We had put her on them to simply crack through the numbers and free up partner time. She was doing them with Irene, but Irene had a leg ulcer to dress so she came in halfway, apparently. I don’t even know if Linda’s told her yet.’
Brenda continued to look puzzled.
‘She’s given a child the wrong injection,’ Cathy said. ‘I’ve just rung up the mother and explained. I’ve sent Linda out to the house to check him over. Egg allergy, and she gave him the one containing it. Jesus. If Irene had been in with her it would never have happened, but there’s no point in going over that now.’
‘I take it he’s alright?’ Brenda asked.
‘The mother, when I phoned, said he had been a little wheezy all morning but she had assumed it was his asthma, ironically the reason for him getting the jag in the first place.’
Brenda leaned back and covered her face with her hands. ‘Oh God. It’s the last thing we need. How was the mother when you called? Angry?’
‘No, not a bit, but that’ll come when it sinks in. I’ve told Linda to admit him for observation to Paeds if she has any doubt whatsoever. I know these things can happen, but what a bloody mess. The worst of it is, that she actually realised her mistake almost as soon as she had done it, it seems, and yet she continued to plough through the clinic hoping it might go unnoticed I assume.’
‘But she came and told you?’
‘After surgery, yes, but had she acted sooner and admitted her mistake, she might have saved the child further risk. It is just what we were saying upstairs about accepting and owning your mistakes. James gave the talk only days before and yet she seems to have panicked and shirked responsibility. At least she owned up in the end, I suppose.’
‘I’ll tell her to contact the defence union for advice if we get a complaint. She might be as well contact them, in any case, to run it by them. There have been a few too many incidents recently,’ Brenda said.
‘Oh? What with Linda?’ Cathy asked.
‘No, just everyone,’ the practice manager said. ‘I’ve just cleared up James’s complaint and another has arrived this morning from the pharmacy about Mark and one of his prescriptions.’
‘Why that came to you and not Mark I don’t know,’ Cathy said. ‘I meant to speak to you and the other partners about an idea that might kill two birds with one stone, after what you’ve just said. I’ve been wondering if it would be worth employing a practice pharmacist for a couple of days a week, perhaps more, to take the pressure off the partners and to tidy up our prescribing.’
Brenda smiled and shook her head. ‘You’d need to make a good case for it, Cathy. You know how tight the other two are and presumably, we’d not get many incentives from the Health Board.’
‘No, I had thought of that too though,’ Cathy went on. ‘It won’t be a popular suggestion but I had wondered about taking on the methadone prescribing for our patients. You know the drug and alcohol psychiatrists have been asking us to help out for years. If we took on the prescription duties: overseeing the patients and managing their medication, the Health Board would offer us a substantial sum to compensate for the inconvenience. I spent a good deal of my psychiatry job on the addictions ward and was in charge of the alcohol detoxers, and I’ve done countless locums before coming here at the homeless practice in town. All I did there was write methadone scripts, so it doesn’t worry me so much.’
‘I worry though, Cathy. You’ve only just come back.’
Cathy rolled her eyes.
‘OK, well I’ll leave that to you then, but I don’t like your chances,’ Brenda said. ‘You know how Mark goes on about the addicts lowering the tone of the place, and Cathy, you have to understand that we have a duty of care to all of our other patients, not to mention our staff. Start running methadone clinics weekly, and we’ll have people hanging about the place and troubling the staff.’
‘Not if we went about it the right way, Brenda. There would have to be some strict rules. We’d never have them in during normal surgery hours perhaps, so as to avoid other patients being hassled. I’d need to think. It’s just an idea. I certainly think we’d do well to look out for an in-house pharmacist though. I’ll talk to Mark and James about it at the next meeting. Perhaps I’ll not mention the methadone clinic just yet though.’
Brenda laughed. ‘You know just how to get around them by now, Cathy. James will take a few days to think things over and to weigh up the risks. Mark might need to believe it was his idea for him to really go for it. I’m sure you’ll talk them around if that’s what you want to do. I suppose now, we just sit and wait for Linda to return and batten down the hatches for the incoming storm.’
8
It was three months to the day since unfortunate Kiean Watts had died. Life for the rest of Glainkirk had moved on surprisingly easily. There had of course been an inquest. Fraser was asked to attend as a witness. He had never been present at such a horribly formal meeting before and knowing now that the blame might well rest on his shoulders, he prayed that it might proceed without the result that he feared.
On the morning of the inquest, Sarah had stood before him. ‘You know you have nothing to concern yourself over,’ she reiterated, touching his neck-tie and moving it slightly to the right. ‘There,’ she said, stepping back. ‘You look wonderful. Authoritative, professional and kind.’
Fraser smiled at the girl. ‘I hope you’re right but they would be within their rights to recommend I see the pharmaceutical disciplinary body after the inquest. It was due to my gullibility that the man died.’
But Sarah shook her head. ‘We don’t know anything of the kind, Fraser. I understand that the police found out he did cash in the other ‘missing’ prescription that morning, but he was horribly devious in the way he managed it. Getting a lift some twenty miles south, to collect it two towns away. How you were meant to alert all the pharmacies in a fifty-mile radius is beyond me. And then he raced back to our shop to put on his act, weeping and wailing about having lost his original prescription, when all the while, the methadone had been in his pocket. No Fraser. I don’t think they’d blame you in the least. These people are notoriously manipulative.’
Fraser stepped aside and looked at himself in the hall mirror. ‘I hope you’re right. Still, I might get a caution or a black mark of some sort. It doesn’t look good. Any future employers will be put off.’
‘Don’t worry about that a bit,’ Sarah said. ‘Get through today and we’ll think about that if it ever happens. I’m sure by this afternoon, you’ll be walking taller with the weight of this dreadful business off your shoulders. We’ll celebrate when it’s all over, you’ll see.’
At the time, Fraser didn’t appreciate how greatly Sarah had steadied him over those dreadful weeks. It seemed that it was the talk of the town, and wherever he went, he overheard Kiean’s name being whispered. Sarah had laughed when he said this and had told him that he was imagining it. When she was out and about anyway, nobody seemed especially interested in the affair anymore. Life had moved on and people were now gossiping about one of the teachers up at the high school who had allegedly been carrying on with a six-form pupil.
As it turned out, Sarah was proved correct. The inquest passed and Fraser, although asked a good number of searching questions, emerged without explicit blame. It was one of those tragic events. Circumstances had meant that the drug user had most likely amassed his own methadone, possibly adding to it, another local addict’s, and had accidentally overdosed. Sadly, another young life wasted to drugs, the coroner had said. He made several recommendations to safeguard against another accident of the same kind occurring, and that was an end to the whole sorry business. Despite the horror of it all, Fraser at
tempted to put it behind him.
Three months on, Fraser sat in the small staff room above the shop. Once again, his life had returned to normal and although he still found himself ruminating on the dreadful Kiean debacle, it troubled him far less. Fraser glanced at his reflection in the glass door of the microwave which sat by the kettle. Things were on the up. His relationship with Sarah had progressed over these past weeks. The girl had all but moved in with him and he rarely had to contemplate an evening alone. He promised himself that the mistakes he had made in the past, he would learn from. Adaptability was the key. It was how all great men developed.
And that lunchtime, it really did seem as if his luck had changed. An answer to his prayers, he thought as he looked at the advert in the pharmaceutical journal. He had initially dismissed it as it was almost too good to be true, but now, rereading the page, something in him stirred. Did he really want to see out his days here in a grotty, little shop? Perhaps this was his ticket to greater things. A more fulfilled life as a practice pharmacist, attached to a doctors’ surgery. The opening was right on his doorstep and such an opportunity. He placed the journal down on the table, and rocking back on the hind legs of his chair, he smiled at a stain on the ceiling. Perhaps his fortune had finally changed, after all.
Washing up his mug, he wondered how Sarah might feel about him applying for this job. She must surely know that he was wasted in a shop pharmacy. They had spoken a number of times about his restlessness. Sarah had thought it was to be expected, given that he had come from such a hectic job before and she had said he might take a while to adjust to Glainkirk’s slower pace of life. Fraser had, at the time, agreed, but now, with this opportunity before him, he felt compelled to apply. Nothing needed to change between him and Sarah. After all, the doctors’ surgery was only on the other side of town. It was perfect.