A Seaside Practise

by Tom Smith

  Alfie then looked round at Manu. ‘Can you take me out of here?’ he asked. ‘Sure thing,’ said Manu, grinning down at him, and wheeled him out, back to the ward.

  I keep Alfie’s little speech in the front of my mind whenever I’m with children. They know and understand far more than we adults credit them with, and they have a very strongly developed sense of what is fair and what isn’t. Knowing these children shaped how I looked after children in general practice, though they were unusual.

  Much more commonplace were the infectious illnesses that still plagued children in the Sixties. Today’s doctors hardly ever see them, but mumps and measles then claimed dozens of lives a year in Britain from the complications of brain infections, and we had our share of these tragic children. The most frightening of these childhood infections for families and doctors alike, however, was meningitis.

  Children struck down by meningitis could then, and can still, go from good health to death in one or two days if it is not diagnosed and treated quickly with a penicillin injection. My hospital experience of children who arrived too late made me swear to myself that I would never be without a penicillin injection in my bag, and that I would never give advice about a child to a parent over the phone.

  It wasn’t long before I was blessing that decision. Sunday mornings in that first summer in the cottage near Braehill were idyllic. I planned the routine visits on the other days of the week, so that on Sundays I had only emergencies to deal with. The Stinchar valley people had proved to be exceptionally considerate: if they needed visits, they almost invariably called before ten in the morning, so that I could organise my travels.

  That first summer in the practice, when we hadn’t yet moved from the Braehill cottage to our house in Collintrae, I would enjoy seeing the odd patient on a Sunday morning, then relax over lunch, and perhaps wash the car in the afternoon. I couldn’t stray far from the phone, as being the only doctor on duty I was on call twenty-four hours a day. But there was plenty to occupy me at home – the fast-growing Catriona, the car to wash, and the river to watch for leaping salmon and the otters chasing them.

  When I received two calls to children in Collintrae at around nine-thirty one warm Sunday morning I was quite pleased to drive the thirteen miles to see them. The families that called me were only three doors apart, so I could walk easily from one house to the other. The two three-year-olds had identical sore throats. They played a lot together, were in the Tufty club together (it was a predecessor of the modern play groups), and one had obviously infected the other with the same germ. Apart from their throats, they were reasonably well, perhaps a little feverish and with aching limbs, but nothing more. I felt able to dispense from my emergency bag a penicillin suspension for each of them, and was confident that they would do well on rest and their mothers’ care. I drove back home feeling that the visits had been worthwhile, and Mairi had a coffee waiting for me.

  She disappeared out of the back door of the cottage while I was drinking my coffee. The phone rang. It was a farmer reporting that his wife had stomach pains, and asking for some advice over the phone. It didn’t sound straightforward, and when I told him I would visit, I could hear the relief in his voice. I walked outside to find Mairi hosing down the car. It was still dripping wet and shining in the sun when I opened the door, explained where I was going and drove off. I left my long-suffering wife standing there with cloth and bucket in hand mouthing what I hoped, but wasn’t sure, were pleasantries.

  The farm was up in the hills above Kilminnel. Like all the hill farmers, the MacTaggarts bred beef cattle, sheep and a few pigs. The animals ranged free all summer over the moorland, and only came into the steading when the calves were going to market and the sheep were sheared and dipped. The house was built on one side of a large square courtyard, two sides being devoted to barns and sheds, and the fourth was open for access to the road.

  I drove into the yard, shut the car door and walked through the kitchen doorway into the farmhouse. It turned out that Mrs MacTaggart’s stomach pains were due to a simple bladder infection which was easily treated.

  Once I had arranged for some medicine for her, I turned to go, but was stopped by the phrase that causes the hearts of all doctors to sink.

  ‘While you’re here, doctor,’ said Mr MacTaggart, ‘could you look at the wee lad? He seems to have a sore throat and is a bit off-colour.’ I didn’t mind at all. I knew wee Sandy MacTaggart. He was always full of energy and had been to see me on several occasions for minor injuries caused by falling off farm machinery or by enraged animals that he had teased.

  Sandy certainly wasn’t himself. Aged four, he too was a Tufty club member, and had been playing with my two little Collintrae patients two days before. He was lying on the couch in the living room, eyelids drooping, tired and listless. He didn’t admit to a headache, but he found it sore to swallow anything. Anyway, he wasn’t hungry – a real change for him. I looked at his throat, saw that it was just the same as the other throats I had seen that morning, assumed he had the same germ, dished out yet another bottle of penicillin medicine and reassured his worried dad. He was bright enough to give me a wave as I climbed into the car and reversed across the yard.

  I was really pleased when I saw Mr MacTaggart waving enthusiastically, too. For a fleeting moment I thought that I must have pleased him a lot, until the world outside the car suddenly disappeared in a thick brown mist. My back wheels were spinning, but my car was moving no further backwards, and the mist was deepening by the second. I put the gear into neutral, stopped the engine and gingerly opened the door. I should have taken it even more carefully, as foul-smelling brown liquid dripped into the car and onto my trousers and sleeves. The back wheels were sunk up to the hub caps in a pile of what I first thought was manure. I later learned that the technical term for this material is slurry, and that I had reversed into the farm midden, where all the animal waste was piled up each year, eventually to be spread across the fields.

  I had interrupted this plan by very successfully spreading the aforementioned stuff all over my car. Mr MacTaggart was most kind. He brought out his tractor, attached a tow rope to my front axle (luckily it had not got as far as the midden) and pulled my car out. He offered to clean the car for me, but it was getting close to lunchtime and I had clothing to change. I arrived home in a car that was a uniform khaki colour, except for the patch of windscreen that I had to clean to see through.

  My reception back at home wasn’t quite as warm as I had hoped. My car, which Mairi had so thoughtfully cleaned only an hour before, was not only unrecognisable but smelled like a badly run sewage works. And my stepping out of the car did not improve the situation. My Sunday suit was not at its best and slurry it seemed was not covered by the usual stain-removal practices. I could remove the clothes, of course, but where to put them was the next question. The keeper’s cottage had a doghouse next door, and it was made fairly clear to me that I and my clothes might like to join the dogs in it.

  So it wasn’t the best of atmospheres in the Smith household when we prepared, finally, to eat our Sunday lunch. I was just pulling my chair back to sit down when the phone rang.

  I sighed, and walked across to the phone. I hoped it wasn’t an emergency.

  ‘Dr Smith here, can I help you?’ I said, hoping I didn’t sound as grumpy as I felt.

  ‘Henry McHarrie here,’ said the man on the other end. I knew Henry well. He was the Collintrae plumber. Everyone call him Happy Henry because, no matter what adversities he faced in life, he always smiled and joked about them. Which was just as well, because he wasn’t exactly the world’s best plumber. After Happy Henry had called, there were times when cisterns overflowed, cold taps ran hot, wc flush levers worked upwards instead of downwards, and radiators leaked. But he was an enthusiast and what he lacked in exceptional plumbing skills he more than made up for in being always ready to help anyone in distress. He was also the goali
e in the village football team. He was a much better goalie than a plumber, and that was enough to keep him popular even among his customers.

  He wasn’t quite as cheerful as usual, however, that day.

  ‘I don’t want you to come out, Doctor’ he explained. ‘Me and the missus would just like a bit of advice about young Thomas.’ Thomas was his two-year-old pride and joy, a late son for the couple, born ten years after they thought they had finished their family of four.

  ‘He hasn’t been himself all morning,’ Henry continued. ‘He started by saying his throat was sore, and he’s a bit hot and sweaty. Just now, he has been a bit sick, and he seems to be rambling a bit. I know you’ve been down to the neighbours this morning, and we wondered if Thomas might have the same as them. Is there anything we can do without you having to come out?’

  That was kind of him, I thought: I could ask him to go next door. It sounded as if Thomas had the same ‘bug’ as the others. The neighbours would let him have a few doses from their medicine that would do until tomorrow. There wouldn’t be any harm in that.

  Then I fully took in what Henry had said. Thomas didn’t just have a sore throat, he had been sick, and he was ‘rambling’. None of the other children I had seen that day had had either of those symptoms.

  ‘I’ll come to see you right now,’ I said, and put the phone down. Mairi looked at me.

  ‘What about this lovely roast?’ she asked. ‘Can you not eat first, then go? Surely the call can wait a few minutes longer?’

  ‘I don’t know if it can,’ I replied, picking up the emergency bag and walking out of the door towards my still fragrant, slurry-coloured car.

  I took fifteen minutes to get to the McHarrie house and a further minute to see that I was faced with meningitis. Young Thomas was lying on his back on the bed, his head arched backwards, his back curved upwards, so that only the back of his head and his heels were actually touching the bed. His spine was stiff, and there was the beginning of a rash across his upper tummy. I pressed a glass against the rash: it didn’t fade under the pressure. I had no doubt about the diagnosis. I was glad I hadn’t waited to eat my lunch. Minutes mattered.

  I gently told his parents what I was doing, and gave him an injection of penicillin. The emergency ambulance was there within minutes and he was away to the Ayrshire fever hospital in Irvine shortly afterwards.

  I wasn’t hopeful about young Thomas, but he recovered well, with no final damage to his brain as far as we could see. Today he is as big as his dad, whom he followed both into the goalposts and the plumbing business, and just as affable. Everyone calls him Happy Tam, and from time to time he offers to wash my car, then laughs like a drain. Which is appropriate, I suppose, for a plumber.

  Chapter Fourteen

  While you’re here, Doc

  I’d like ‘While you’re here, Doc’ on my tombstone. It’s the phrase that doctors have nightmares about. The TV detective Colombo knows exactly how to use it. You surely know the series. Our raincoat-clad hero shambles to the door after a seemingly painless interview with the man we already know has committed the murder. He thinks he has got away with it. As Colombo puts his hand on the door handle, he turns, puts a finger to his forehead in puzzlement, looks at his quarry, and says,

  ‘There’s just one thing that’s worrying me.’

  That scene, slightly changed, is repeated time and again in a doctor’s life. Except it’s the patient that remembers, at the end of the consultation, the vital thing that he or she really needs to know about. It’s called in the trade ‘the hand on knob’ question.

  In my early days, in Birmingham, the hand on knob question was almost invariably about contraception. The ‘pill’ had just been introduced, and couples were still shy about asking for it, or even talking about sex at all. It took a decade or more for people to lose their shyness about it, especially with a young male doctor like myself.

  In the Stinchar valley, however, my country patients were much more direct. Having animals all round them, sex was just a matter of course. They could organise that for themselves without any help from me. No, their hand on knob question was usually quite different.

  The first time it happened was on a wild March night. I had been called by a farmer, Rab Jackson, because his wife had a bad cough, had chest pains and ‘was a bit breathless’. She had had it for a few days, he said, but now he was worried because she hadn’t been fit enough to make his evening meal, and was just lying on the sofa, ‘wi’ no enough puff tae get up’. Could he possibly be more concerned that his food wasn’t on the table than that his wife was ill? Surely not.

  The farm was about six miles from Collintrae, at the end of a winding country road, and it took me about fifteen minutes to get there. As I got out of the car I could see that men were flitting about in the byre – the cowshed – next to the house. One of the men called to me from the byre doorway. His back was to the light streaming out from the byre, so at first I didn’t recognise him.

  ‘Hey, Doc, seeing you’re here, could you give us a hand?’ It was Rab.

  I walked over to him, to find that he and another man were in the middle of a maternity case. It wasn’t human, of course, but a cow. The poor animal was standing with her back to me, rear legs wide apart, with a large wooden tripod contraption fixed up against her nether end. The tail had been tied up out of the way, and a thick rope was projecting out of her birth orifice. The near end of the rope was wrapped around a drum on a winch: the far end, I gathered, was tied around the presenting part, hopefully the front legs, of the unfortunate calf deep inside her.

  I assumed that this was the bovine equivalent of a forceps delivery. The aim was to start the winch as soon as the cow’s womb contractions came, so that the rope was pulled only along with the contractions. The tension in the rope was eased when the contractions stopped. Pulling at the wrong time could pull the uterus out with the calf, killing both. The men’s problem was that with one man at the winch and the other leaning on the tripod, they needed a third at the cow’s belly to feel for the contractions. I was a godsend – not only could I help them, I was surely used to feeling for contractions, though hardly of such a massive nature.

  I stood beside the cow with a hand on its underbelly and listened to it bellow as another contraction started. There was no gas and air to ease the pain. I signalled the winchman to start up, and the rope became taut. It took another two contractions before suddenly the calf was born, falling three feet from the birth canal on to the concrete floor of the byre. The men didn’t think this was a problem – and it wasn’t. After a few minutes the calf shook itself and his mother bent round to lick him and start to eat the membranes.

  I marvelled at the sight and, a few minutes later, marvelled again to see the calf stand up shakily and search for his mother’s teats.

  There were back slapping and grins all round.

  ‘Good job well done,’ roared Rab. ‘Come in and have a wee half to celebrate,’ he added.

  ‘But I’m here anyway to see your wife,’ I said, now a bit guilty that the calf seemed to have taken preference over the human patient.

  ‘Oh aye, so ye are,’ he replied, and led me into the kitchen.

  Only in the light of the kitchen did I now see that I had been standing in cow dung and leaning hard against the side of the animal with my shoulder. The animal, understandably, hadn’t had a wash for some time, if ever. However, this didn’t seem to matter to Rab, who was in a far worse state than me, having slipped in the mess of afterbirth and manure on his way out of the byre. He just barged on into the sitting room as he was, to introduce me to his wife, Ellen, who was sitting by the fire.

  She looked wearily up at us as we entered the room.

  ‘My God Rab,’ she wheezed. ‘Whit have ye been daein wi’ the Doctor?’

  I stopped, and half turned back to take my coat off, but Ellen stopped
me.

  ‘Don’t worry, Doctor,’ she said. ‘I’ll clean oot the place when I’m feeling a wee bit better.’

  I walked over to her and began to ask about her illness.

  It soon became clear that she was much more ill than Rab suspected. She had pneumonia. It had affected both lungs, and she was not just breathless but going blue with the mildest exertion.

  I had to decide what to do, fast. She should really have been in hospital, but the night was wild, the farm road very bumpy (Rab was not one for mending the potholes) and the hospital more than forty miles away. I felt that to keep her at home was the better option, provided she could have good nursing care. Rab wasn’t exactly the ideal person to provide that.

  I first gave her an injection of penicillin and streptomycin – the best treatment then for pneumonia – and called Nurse Flora. She was with us in twenty minutes (her Morris Minor was slower than my Oxford, and she was a more careful driver), breezing into the room like a breath of fresh air. It was much needed, as by this time the warm farmhouse air had spread our miasma of cattle body fluids and worse throughout the room.

  Flora took one look at me, and grinned. Then she tended to Ellen. Rab and Ellen’s bedroom, luckily, was on the ground floor, and Flora and I carried her into it, and settled her into the double bed, arranging the pillows so that she could half lie, half sit up, in the most comfortable position for someone with pneumonia. Flora and I talked about how best she could be treated over the next few days, then we both returned just in time to see Rab walking out of the door – apparently to see how his new calf was doing.

  Flora exploded. I witnessed something close to what the generals in the Crimea must have faced when confronted by Florence Nightingale after the battle of Balaclava. Flora told Rab in no uncertain terms, that when she returned the next day, the kitchen and bedroom had to be spick and span, Ellen was to have had her breakfast, and to be washed and resplendent in her best nightie. Rab was to arrange all that himself, and then he was to get someone in to look after her. Ellen was not to do a thing – ‘no cooking, no housework, just nothing’ - for at least three weeks. Rab, over six feet tall and not an ounce under eighteen stones, stood there and took this angry admonition from Flora, no more than five feet tall and seven and a half stones, in blushing silence.