A Seaside Practise

by Tom Smith

  ‘The hotel is closed for Christmas,’ she said, beginning to panic. ‘There’s no one here to give us a room.’

  Just at that moment the ambulance drove up. The two ambulance men and I lifted Carol out of the car, placed her on a stretcher, and wheeled it into the back of the ambulance. That’s where we delivered her of a healthy baby boy, seconds later.

  I eventually sat down to my Christmas dinner a few hours late. It was worth waiting for. Sitting in the lounge with Mairi and Bessie afterwards, I mentioned that I thought I was going to miss out on Christmas completely, but Bessie reminded me that I had a more complete Christmas than most. After all I had met a Christmas Carol, and delivered her of a baby boy when there was no room at the inn.

  Two days later, Carol and her new baby left the hospital against our advice. When I went back to Auchencleoch a day later to check up on her, the family had gone, taking with them their few sticks of furniture. They had left only the donkey, which the local innkeeper, the one who was away for Christmas, was glad to look after. We never heard where they went, or how they managed to survive. It turned out that they had been squatting in the house. The boys hadn’t, in fact, been enrolled in the local school. We presumed that they didn’t want to be traced officially for whatever reason. We are not even sure they gave us their real names.

  The next day the ‘flu hit the practice with a vengeance. I had six calls that morning. The numbers expanded to twelve, then twenty and by the end of the week I was seeing thirty ill patients a day, and dealing with another twenty or more on the phone. Jimmy Anderson helped out, as did the two nurses, who both caught it and tried to struggle on.

  Despite being in the midst of all these ‘flu cases, I didn’t catch it.

  Charlie Welsh didn’t catch it either. He came to see me on New Year’s Eve.

  ‘Remember I said that we’ve had a winter of bird deaths before? It was 1957,’ he said. ‘The birds aren’t dying any more,’ he added. ‘Whatever killed them seems to have passed. Do you know, it’s a funny thing, but ‘57 was the only time I’ve had ‘flu. Do you think there is a connection? I hear there’s a lot of it about now.’

  I remembered Christmas 1957, my first year at medical school, very clearly. I was in the university sanatorium, with ‘flu. I still have the scar on my right lung to prove it. That winter hundreds of thousands of people all over Britain had caught the worst ‘flu for many years.

  ‘I’ve never heard of ‘flu being transferred from birds to humans,’ I said, ‘but I suppose it’s possible.’

  I should have taken Charlie’s suggestion more seriously. Forty years later, the experts were worrying about people dying from bird ‘flu in China, and they have uncovered a lot about how ‘flu epidemics have spread via seabirds.

  They are fairly sure, for example, that the great pandemic (the Spanish ‘flu) of 1918, that killed 20 million people in four months as it spread around the world, started with pigs. They are still puzzling over the epidemics of 1957, the Asian ‘flu I caught as a student, and 1968, the Hong Kong ‘flu that hit us that Christmas. They do know that people who caught the Asian ‘flu were immune, as Charlie and I were, to the Hong Kong variety. They also seem to be immune to the swine ‘flu of the spring of 2010, that is thought to be identical to the Spanish one of 1918.

  The names relate to the first place that the ‘flu virus was found. The puzzle for the British experts is that in 1957 the first case of Asian ‘flu in Britain was reported from Stornoway, in the Outer Hebrides. In 1968 the Hong Kong ‘flu started in the Black Isle, north of Inverness.

  Why is that a puzzle? Because the ‘flu virus, once you inhale it from another infected person, takes only two or three days to produce the illness. It doesn’t make sense that the first cases would be in places so far from the usual ports of entry into Britain. Anyone carrying ‘flu caught abroad would have become ill before they reached areas like Stornoway and the Black Isle. Far more feasible is a spread from the sea. Were those dead birds the real clue to the ‘flu epidemics of 1957 and 1968? Charlie Welsh and I believe they were, but then, we’re not experts.

  Chapter Eighteen

  Teeth…

  Teeth have never been a favourite of mine. If I wanted to deal with teeth, I would have been a dentist. That certainly was never my ambition. Don’t get me wrong. I have good friends who are dentists. In fact I have run half marathons alongside my dentist, although he swears it’s only so that I can see him in pain for a change.

  My first school was in Glasgow – before my father’s translation to Lincoln. I still remember my class teacher in that last year. Mrs Routledge (with the obvious nickname Rusty Legs) was large and fat, wore tweed suits, a stained cream blouse, thick stockings and brown brogues. I spent a lot of time looking down at those shoes, because it was her rule that we bowed our heads when she belted us.

  It was Mrs Rusty Leg’s wont to spend a substantial part of each day hitting her class of seven year olds with a belt – a mode of teaching which has thankfully fallen out of fashion. The official name for her instrument of torture was the Lochgelly tawse. A thick black leather strap with a divided end, like a snake’s tongue, it was brought down on your hand with great force. It hurt badly enough when it hit the palms of your hands, but if her aim was out, it caught you across the wrist, and that was really sore. But you stood and bore it, for even at seven years old you knew not to cry out. If you did you got another stroke. We all soon learned, too, that on the days her breath smelled stale and sweet, she was more likely to belt us, and to hit our wrists, than on the days when it didn’t.

  We were belted if we were late for school in the morning, for talking in class, for not paying attention, for not being quick enough with our answers, indeed for anything Mrs Rusty Legs could find wrong that allowed her to inflict pain on us. I used to travel to school on the tramcar, and if the tram broke down and I had to run the last few hundred yards, rushing in at the last minute, breathless, I was belted. Even if I had made the class in time, I was belted because I was out of breath.

  What I remember most about Mrs Routledge were her teeth. They were long, yellow and crooked, splaying outwards, with the top ones overlapping the bottom lip so that she always looked as if she was biting it. Sometimes her gums showed, red and swollen. This arrangement of gums and protruding teeth gave her a permanent grimace that turned into a wide grin when she was angry with us, which was most of the time

  Having teeth like that in those days was unusual. In the first half of the twentieth century it was common for people to have all their teeth pulled out, even if they were healthy, to prevent them from catching lethal infections like pneumonia or scarlet fever. It was thought that germs could get into your bloodstream through your teeth and gums, so in those days before penicillin taking out all your teeth seemed a reasonable thing to do. That is why very few people had anything other than two perfect rows of shining white, even teeth, at least in public. In private, these ‘perfect teeth’ came out at every opportunity, even, or perhaps especially, at mealtimes. It was easier to chew with your gums than with the ill-fitting teeth that were issued by the average dentist. I remember my parents’ bedroom, with ‘his and hers’ glasses by their bedside into which the teeth went every night. They told me about having their own teeth taken out at home, the job being done by a house-visiting dentist who used an ether rag and bottle, then took the teeth out in a great hurry before they ‘came round’. The pain and nausea afterwards was almost unbearable.

  So old Mrs Rusty Legs’s teeth were unusual. We kids wondered, when we were able to talk in the playground, how they came to be so bad. We reckoned that she was scared of going to the dentist – she could dish pain out, but couldn’t take it – a thought which gave us huge comfort.

  Then one day she entered the class, tears running down her cheeks. She faced us, then said: ‘Children, this is the saddest day in our history.’

  The
front wall of the room, behind her desk, was almost entirely filled by a blackboard fixed to the wall. Rolled up above the board was a huge map of the world. She tugged the cord at the side, and the map unfurled. She called us to attention in our seats, then used her long wooden pointer to fix our eyes on the large red inverted triangle of British India.

  ‘Today, India has betrayed our glorious Empire,’ she said, sobbing. ‘From now on, we will have to colour India green. The Union Flag will no longer fly over India, and it will only be a matter of time before the rest of the red countries on this map will follow suit. You will live to see the end of the British Empire. I am glad that I will not.’ She took out her handkerchief and blew her nose hard into it.

  The boy sitting beside me dug me in the ribs and sniggered secretly at me, hugely amused by seeing our tormentor so upset. I grinned back at him, and she saw me. I was called to the front. I had caught her on a bad day. Her breath was sickeningly sweet and sour at the same time. She gave me four strokes, two on one hand, two on the other. As I went back to my desk, I had my first political thought. If losing India had upset old Rusty Legs so much, it must be a very good thing.

  One morning about a month later we had a new teacher. She was younger and kinder and liked to laugh a lot. Mrs Routledge never returned. We heard that she had become very ill, and could no longer teach us. Only a short time afterwards she died. Years later, at medical school, I smelled breath like hers again. It was the odour of acetone. For the first time I felt sympathy for our persecutor. She had suffered badly from diabetes: it was probably the cause of her bad teeth and the reason why her dentist would have shied away from extracting them. At a stretch it might even have explained her bad moods and aggressive behaviour, although I don’t think my forgiveness can stretch that far.

  About a year after I arrived in Collintrae, our postman, Jackie Logan, knocked at the front door. He didn’t usually knock: he just dropped my pile of journals, health service mail, drug company advertising and bills on the mat behind the open door and left, glad to offload his biggest burden of the day. This day, however, he wanted to see me.

  ‘Morning Doc,’ he said. ‘I wonder if you would call in on Miss Wallace at Tam’s Well Cottage. When I left her mail today she wasn’t looking so good, and she didn’t give me her usual banter. I don’t know if she’s ill, but I thought I’d better tell you.’

  ‘I don’t think I know her,’ I said. ‘She hasn’t been to see me. Have you ever found her like this before?’

  ‘No,’ Jackie replied. ‘She keeps herself to herself, and doesn’t get out much. All her groceries are delivered, and she has given up her car. And most of her friends are gone now.’

  I told Jackie I’d see her, and walked into the surgery to look for her notes.

  They were blank. Not just blank since I arrived, but blank since the official records were compiled at the beginning of the Health Service in 1948. There were no notes of any illnesses before that, either. It was usual for any pre-NHS notes to be stuffed into the cover of the NHS ones. Her notes were the thinnest of any I had met with in the practice – just an envelope with her name and date of birth and no contents.

  I had a second ‘take’ at her date of birth. It showed her to be ninety-eight years old – and she was living by herself in a cottage three miles out of the village, with no other homes around her. A ninety-eight-year old on her own with no neighbours usually meant a lot of work for doctor and nurse, but there was no evidence that she had bothered either.

  The surgery finished early that morning, so I drove to Tam’s Well wondering what she would be like. I walked up the winding path past flowering rose bushes and a manicured lawn to the freshly painted front door. I could see, through the window beside the door, an elderly woman sitting hunched in a chair beside a fire. She was side-on to me, so that she didn’t notice me until I rang the bell. Miss Wallace took a little time to rise and walk slowly to the door. It opened a little, and she peered out at me.

  ‘Wha’re you?’ she asked. ‘Whit are ye daein’ at ma door?’

  There’s nothing like politeness, I thought, and this was nothing like politeness.

  ‘I’m the doctor. Jackie the Post asked me to call. He didn’t think you were looking too well.’

  She hesitated for a moment, then looked down at the bag in my hand and the stethoscope earpieces sticking out of my pocket. I must have convinced her I was the genuine article, because she stepped back, opened the door further and let me in.

  ‘Jackie’s got nae business callin’ ye out on ma behalf, but seein’ ye’re here ye may as well hae a look at me,’ she said. ‘I dae hae a sair thrapple.’

  So she had a sore throat, she looked flushed and she was cross. I wondered if she was always cross, or if illness had made her this way. I had a fleeting memory of old Rusty Legs, but pushed it aside. Miss Wallace was neat and spry, and just a bit cantankerous. If she had a sore throat I could forgive that.

  She settled in her chair and I asked her to open her mouth. She had two rows of perfect white teeth, even and strong – obviously false.

  I smiled at her, and asked the question that made me a laughing stock for years around the village.

  ‘Could you take them out, please, so I can have a clearer view of your throat?’

  ‘Tak’ whit oot?’ she said, indignant.

  ‘Your teeth,’ I replied. ‘It’s easier if the top plate doesn’t fall down while I’m examining you.’

  ‘Ah canna tak’ them oot,’ she almost shouted, ‘they’re a’ ma ain.’

  They were all her own. Miss Wallace, at ninety-eight, had thirty-two perfect teeth in her head. No fillings, no chips, no decay, and gums without a trace of swelling or recession. She was a miracle. Not only had she never seen a doctor, she hadn’t seen a dentist, either.

  I was no miracle, on the other hand. I wished the floor would open up and swallow me.

  ‘Whit kind o’ a doctor are you’, she continued, ‘that canna tell real teeth frae wallies?

  Then, thankfully, she laughed. ‘Wait till ah tell my freens aboot this yin,’ she said.

  We got on well after that. Her throat was sore, and I started her on her first-ever course of penicillin. She asked me to have a cup of tea with her, and then sprung her next surprise. She went to the door of the room and called up the stairway.

  ‘Effie, will ye come doon a minute? I’d like the doctor tae see ye.’

  I heard a door close and footsteps come to the top of the stairs. I joined Miss Wallace at the foot of the stairs and, looking up, saw Effie. She was small, thin and stooped, with balding grey hair. She wore a long grey woollen skirt and a blouse and cardigan that had seen better days, but were clean and tidy. She walked down the stairs very carefully and slowly. She looked dully at me, then at Miss Wallace, who smiled at her. She didn’t smile back, but shuffled past us into the sitting room and sat down in a chair in the corner. She looked at me without curiosity and with dull eyes.

  ‘Effie’s been a bit off-colour for a day or two. I wondered if she has the same throat as me. Could ye tak a look at it?’ Miss Wallace asked.

  ‘Sure,’ I said, and turned to Effie. ‘Hello Effie,’ I said, offering her my hand to shake. ‘I’m the doctor. Are you not feeling well?’ Effie looked at my hand, a frown on her face, glanced at Miss Wallace, then stared back at me. She kept her hands on her lap, and didn’t reply.

  Miss Wallace smiled at me, and shrugged. ‘Effie won’t answer you,’ she said. ‘She doesn’t speak. But I know how she is when she’s feeling no’ weel, and this is one o’ thae times. She’ll let you look at her. It’s just that she isn’t used tae men aboot the hoose.’

  I turned back to Effie and gave her my best reassuring smile. ‘Could I look at your throat?’ I asked. She glanced again at Miss Wallace, who nodded, and she opened her mouth. She too had two rows of fine white filling-free t
eeth.

  I looked back at Miss Wallace and grinned.

  ‘Dinna ask,’ she said, laughing. ‘They’re her ain, too.’

  Effie had the same sore throat. I rummaged in my bag for another bottle of penicillin tablets.

  ‘She’s not allergic to antibiotics?’ I asked.

  ‘She’s never had them,’ was the reply.

  ‘Then it’s safe to give them,’ I said, and handed over the pills. Miss Wallace took them, and told Effie, kindly and gently, that she could go back upstairs to her room. Effie stood up and walked out without saying a word. I watched her struggling up the stairs and heard the door shut above us.

  I still didn’t know who she was, but I knew exactly what was wrong. Not from my medical training, but from my days as a nurse in the Lincoln hospital. The lack of emotion, the inability or unwillingness to talk, the blind acceptance of what was happening to her, all suggested a long-standing mental illness or handicap. But who was she?

  Miss Wallace explained. More than fifty years before, she had signed up with the local mental health authorities to take in ‘boarded-out patients’. The system was unique to Scotland. People who could not cope independently in normal society, but who were no risk to others or to themselves, were offered as permanent ‘guests’ to families who would give them a home and company. The council found maintaining the boarded-out system much cheaper than keeping people in hospital, so they paid the costs. Miss Wallace had received a small cheque each week for over half a century: it kept her and Effie comfortable, and they didn’t need much. Everything they ate came from their vegetable garden, their hens, their sheep and their cow. They made their own bread, and their own clothes from the wool. They were true crofters, working their two acres of ground behind the cottage together.