by Tom Smith
Effie’s real name was Euphemia Morrison. She was twenty-seven when she was ‘given’ to Miss Wallace: she was now eighty-one. The two women had lived together in harmony all those years without bothering anyone. They didn’t really want to bother me. Nor did they wish to bother the authorities. Miss Wallace was worried that someone at ‘the office’ might realise how old she was and take Effie away from her. Without Effie, she said, she would have little to live for, and Effie was a great help around the house and garden. The boarded out scheme had stopped years ago – the two of them had somehow been forgotten, and left alone. The money kept coming in from a trust fund set up before the war by the local authority of the time, and while Effie was alive, it would keep coming. Miss Wallace pleaded with me to let things continue as they were, and I was happy to agree.
As for the teeth, Miss Wallace put their health down to their water supply, which came from a spring in the hillside above the cottage. I didn’t express an opinion. Back at the surgery I found the notes of Miss Euphemia Morrison. They were almost as thin as Miss Wallace’s. Except that they contained a letter dated 1912, from a hospital doctor to the GP in Collintrae at the time.
It explained that Miss Morrison had been mute since the age of fifteen, when she had been found alone in her home beside her dead mother. How her mother had died was unclear. There were suspicions that Euphemia had had something to do with the death, but it could not be proved. She was obviously ill, with what was labelled then as ‘dementia praecox’, and would now be called paranoid schizophrenia. After twelve years in hospital, it had been decided that she was harmless, and could be boarded out. Miss Wallace’s home had been inspected, and found to be ideal. The only other notes in Euphemia’s record were acknowledgments of annual visits made by the mental health authorities until 1945. After that, nothing. It seemed that there was no one left at ‘the office’ who knew about them.
I read the letter again, and remembered Mr Evans and Mr Brown from my time in Lincoln. I wondered how safe Miss Wallace really was, then dismissed the thought. Should I explain my worries to the current psychiatric team? If I did, they would take Effie away, and that would be the end of Miss Wallace. If I didn’t, they would probably continue to live amicably together. I decided to say nothing.
Miss Wallace survived until she was 107, sharp as a needle to the end. Euphemia died aged eighty-eight, two years before her, peacefully in her bed, never having spoken a word, until her last few moments. All she said then, quietly, to Miss Wallace was ‘Thank you.’
Chapter Nineteen
Goodbyes
Jenny looked up at me and smiled. ‘You know, Doctor,’ she whispered, ‘my mother wanted to call me Victoria. But my dad didn’t like the name. It would have been funny, wouldn’t it, if he had.’ Almost imperceptibly, her head shifted back into the pillow. The smile stayed for a while, then slowly faded. Her eyes didn’t close: they kept staring, steadily, into mine. But they were not seeing me. Mrs Jenny Plum had kept up her good humour to the end.
It was three in the morning. The light beside her hospital bed in the small side-ward was dimmed, the hospital eerily silent, as if all the rest of life had stopped just for this moment. I gently stretched my hand out to close her eyes, and tiptoed out through the gap between the curtains to tell the night sister.
That was more than forty years ago. I’ve never forgotten Jenny. We had met at the hospital outpatient clinic only a month before. Just twenty three, she was thrilled to be pregnant. Everything was fine, except that her abdomen was much bigger than it should have been for its ‘dates’. She had joked about that, too.
‘If I keep on like this,’ she had laughed, ‘I’ll have quins – or an elephant.’ I didn’t laugh with her. I had only read about this type of pregnancy in the textbooks. Inexperienced as I was, I feared the worst. I knew it could be a chorionepithelioma, a form of cancer of the placenta, that was fatal within a few weeks. I called the consultant, who felt her abdomen, nodded briefly to me, and calmly arranged admission to the ward.
We didn’t tell patients the truth in those days. The chief decided that we were to call the problem a ‘malformation’ that would need time to cure, and that it would be best for her to stay in hospital in the meantime. He also decreed that we should keep her and her husband in the dark until the last possible moment. He then left the details of her care to the nurses and to me, the most junior doctor.
I realise now that she knew the truth from the start. She just didn’t want me to know that she knew, so she played along with the charade. I learned so much from her about how to die with courage and dignity, and all I could offer her in return was my company as often as I could spare it. Her husband visited less and less, and once he was told that there was no hope he stopped coming, because he couldn’t lie to her face. He was only twenty two himself, and I’m sure Jenny understood why he couldn’t face her, and forgave him for his absence in her final week.
By the end of my fourth year in Collintrae, I was facing a similar problem, but it was much more personal. Bessie, Mairi’s mother, had fought breast cancer for nearly ten years, and was now living out her last few months in our home. Like Jenny, she never complained, and also like Jenny she knew that her case was hopeless. Yet she didn’t talk about it to Mairi or myself until her last evening.
It was Prince Charles’s twenty-first birthday, and there was a television programme about him and the Royal Family that she wanted to watch. As it ended, she turned to us and said ‘I’m finished’.
I helped her upstairs to her bedroom, and Mairi put her to bed. Catriona, now aged four, padded through in her slippers to kiss Grandma goodnight. Alasdair remained in his cot, sound asleep. Bessie, now lying back against the pillows, looked at me and asked for her injection: she was on a cocktail of drugs to ease her pain, now constant. Jenny came into my mind as I slid the needle under her skin. As I removed it, Bessie turned her head slightly and gave a sigh. She smiled wanly at her granddaughter, then fell asleep.
She didn’t wake up. The next morning we had a lot of thinking to do. The practice had grown in numbers and in workload over the four years. Surgeries were busier, there were more calls for visits, and medicine had changed. We had far better drugs to treat asthma, high blood pressure, heart disease, infections, stomach ulcers, and diabetes, but they came with a high price, not in money, but in the need to follow-up patients with all these illnesses. It meant establishing regular clinics for them all, employing staff, enlarging premises and constantly keeping up to date with all the medical innovations.
It was obvious that the practice needed another doctor. It was also obvious that Mairi needed help. She was the receptionist, practice manager, dispenser and patient pacifier when I wasn’t immediately available. She was on call day and night just as much as I was. Except that she wasn’t paid for her work. At that time doctors’ wives could not be paid: they were expected to give their services to the practice free.
It was clear that if the local medical committee did not provide the funds for a second doctor, we would have to rethink our future. Now that Bessie was gone, we had no family commitment to the area. If we had to leave I would deeply regret leaving the patients, but the rest of the family needed a break. Mairi needed a lot more support than I could offer with my limited time in the home, and the children needed to see me as a father, not as a stranger who was only home when they rose in the morning and after they had been put to bed at night.
I wrote to the local health authority about the possibility of creating another GP position in the district. The reply was curt and to the point. Of course I could have a partner, provided his or her salary came out of my pocket. So we started to look around for a new life.
What could we do? I wasn’t keen to go back into partnership: my Birmingham experience had soured me for that. It would be good to do something different for a while, perhaps a nine-to-five job that would give us some family life. B
ut what? Medicine didn’t offer many jobs like that.
The first three months of any year are hard for single-handed country doctors, with their toll of illness and extra deaths among the elderly. They are not so bad if there are plenty of days of sunshine and calm weather, but if they are dark, wet and cold, people fall prey easily to depression and feeling unwell. Surgery attendances rise and the numbers of home calls rocket.
As if to test my already waning endurance, from January to April 1970 we had relentless rain and wind. Storm after storm hit the Ayrshire coast, the toll on the people of the Stinchar Valley was high, and the workload for the practice, and for Mairi especially, was high. We knew by Easter that we had to get out. My journal reading started with the ‘Appointments Vacant’ column rather than the editorials.
In early May one of these appointments caught my eye. It was for a doctor to join the research team of a drugs company. It would mean learning about the development of new treatments and organising their trials in university departments all over Britain. That sounded interesting, but what really struck me was the name at the bottom of the advertisement. Vivian Lewis had been one of my tutors at Birmingham: I reasoned that if he was heading the group I would get a good training, and would have an extra string to my medical bow. On impulse, I phoned him. He remembered me, and instead of asking me to come for an interview, said that he would travel up to Collintrae in a week’s time, to interview me at home.
The day of the interview started badly and got worse. The telephone wakened me at seven in the morning. It was Duggie Shearer, whose farm, Ailsa Mains, ran along the coast north of Collintrae. He sounded in a panic.
‘Doc, could you come at once?’ he said. ‘I’ve got six men here who’ve had heart attacks in the night. They’re a’ writhin’ aboot in agony wi’ chest pain.’
One heart attack in a night for any doctor is commonplace. Two is stretching it a bit. Three is unheard of. But six!
‘Hold on,’ I said, ‘I’m coming, but first I need to know a bit about them. Who are they, and when did their pains start?’
‘They’re howkers,’ he said. ‘This morning, when they woke up, they could hardly breathe, the pains in their chests were so bad. They cannae get up from their mattresses. They’re yellin’ and screamin’ wi the pain. Ye’ll need tae dae something.’
Howkers were a very special group of people. They came to Ayrshire every year, from May onwards, to pick, or ‘howk’ potatoes. The ‘Tattie Master’, Hugh Gibson, lived in Fife. The farmers planted the tatties in January, and Gibson organised the harvest four months later. Once the crop was ready for lifting, he brought over, by lorry, hundreds of ‘howkers’ from Ireland, from County Cavan and County Clare. They lived in sheds and byres provided by the farmer, and by day followed the machines that turned over the ground and spewed the potatoes over the earth. It was back-breaking work that lasted from dawn to dusk, bending, lifting, heaving, sorting and bagging the potatoes. The howkers were exhausted by the end of the day, going back to their sheds only to eat and to sleep. They were so tired that nothing would waken them in the night. They slept the sleep of the dead each night, in rows, on mattresses and on the straw, usually fully dressed, ready just to wash in the yards and be transported to the fields each morning. I would see them occasionally at the surgery for minor injuries. They were great people, hard-working and never complaining, however rough their lot was. They sent most of their pay home, only holding a little back for a few essentials each week.
When I arrived, I could see I had a real emergency on my hands. The patients were lying, some on their backs, some on their sides, moaning and clutching their chests. They were all in one area, partitioned off from the rest of the men and women by a wooden wall. The rest of their group were standing around, anxious and completely at a loss at what to do. They parted to let me through to the scene of the ‘epidemic’.
There were, in fact, seven men lying in the section. The six nearest me were the ones with the sore chests. The seventh was lying in the corner, curled up in a ball, sound asleep, facing the wall. I bent down to talk to the first man. He was holding his arms across his chest, hugging himself tightly. He explained that it was the only way he could breathe without great pain. I could see that he was breathing only with his diaphragm - his stomach was rising and falling with each breath, but he was making sure that his ribs weren’t moving. I looked briefly across at the others: they were all doing the same: whether they were on their sides or on their backs, they were desperate not to move their chest muscles.
‘When did this start?’ I asked the man nearest me.
‘I woke up with it,’ he said, grimacing at the effort he had to make just to speak. ‘So did all the others.’
The second and third men nodded their agreement. It seemed that they had all wakened early, around five in the morning, with pains in their chests. Only when the gaffer had come round to wake them up, at seven, were they able to tell him about their strange affliction.
I had not the slightest idea what this could be or why, for that matter, the man in the corner could have slept through it all. I asked the first man to open his shirt, so that I could examine him more closely. It took a major effort from him to lever himself up into a half-seated position, unbutton his shirt and lift up his vest.
The front of his chest showed a series of disc-shaped red spots about a centimetre across, separated by two or three centimetres. When I put pressure on his chest he yelped. Pressure from the sides hurt a lot, too. He had severely bruised, if not broken ribs. The chests of all the other men in pain showed exactly the same marks, and they had the same signs of rib damage.
The cause was beginning to dawn on me. I asked the first man when they had gone to bed.
‘We all went to sleep about midnight,’ he said, ‘except for Sean over there in the corner.’
Sean was snoring peacefully, still curled against the wall.
‘So when did he get to bed?’ I asked.
‘We don’t know,’ said the man. ‘He was out on the batter, and we must have been asleep when he came in.’
‘But he would have had to climb over you to get to his place, wouldn’t he?’ I asked.
‘To be sure,’ he replied.
I stepped gingerly between the men over to Sean in the corner. He smelled very strongly of whisky, was unconscious to the world, and on his feet were his hob-nailed boots – in the vernacular, ‘tackety bits’. The hobnails matched exactly the pattern of spots on each man’s chest. Sean’s boots were the cause of all their concerns.
I could do little to help them all, other than to prescribe some painkillers and suggest that they get up and about as soon as they could bear the pain. They were a gentle lot, so they forgave Sean his walk over them, but I heard later that he was condemned after that to the spot nearest the door, where the wind and the rain would punish him for his transgression.
I drove back home, and prepared myself for the morning surgery and for the interview that was scheduled for around noon. The surgery passed routinely until the phone rang again. This time it was Willie Tait, the polis.
‘Sorry about this, Doc,’ he said, ‘but we need you straight away, at Cranhill. We’ve got a man on the roof and he’s slinging slates at us. We gather he needs some counselling.’
Cranhill was an isolated house about six miles away, on a side road in the hills. It had a driveway about forty metres long sloping down to the front door. Built on the side of a hill, behind it was a sheer drop down to the River Tig, a tributary of the Stinchar, about a hundred feet below.
I knew who the man was without being told. David Marshbank had been a family doctor in Bristol for many years. Then, in his fifties, he had been sued by a patient’s widow. It was something to do with a wrong diagnosis that had led to the patient’s death, and the widow had blamed the doctor. I never knew the details, but sympathised with him. It happens
at some time in our career to many of us, and we have to develop a thick skin to survive a case like this.
Dr Marshbank’s skin was not thick enough. He had broken under the strain, and had had to retire from practice. He felt that his fellow doctors had not given him enough support at the time, and that he had been unjustly pursued in the courts and ignored by his local medical committee. He had had to leave his old practice area, and he and his wife had taken the Cranhill house as a hideaway from the realities of their lives.
It hadn’t worked. Over the months that followed he had changed. He started speaking in French, a language that he had not used since his schooldays. He put up notices around the outside of the house, in his garden and at the gate, in French, for people to stay away or be ‘fusillé’. He would remonstrate in French against anyone walking by his door. Naturally, as most of them were locals, they hadn’t understood a word. Everyone gave him a wide berth, which was sad, because he and his wife became ever more isolated, and cut off from their new community.
I told Mairi where I was going and left the Cranhill number so that Dr Lewis could phone if he arrived before I returned. She wasn’t happy that I was going to visit someone who was throwing slates about, but there was no alternative. It was all part of the job.
I arrived at the same time as the Fire Brigade, old friends from my trips down cliffs. The ambulance was already there, along with two police cars. Those who had been brave enough to get out of their vehicles were standing behind the thick trunk of a large old yew tree in the front garden. The side of the tree facing the house had six or seven slates embedded in it at around head height. As I approached, another slate whizzed through the air and thudded into it.
On the roof, busy prising yet another missile from it, was Dr Marshbank. He was amazingly nimble for his sixty years. He saw my car arrive and stopped his fumbling with the slate.