‘Mr Bletchley?’
The eyes stared briefly in my direction.
‘Yes.’
I sat down opposite him and extended a hand across the table. ‘Pleased to meet you Mr Bletchley. I’m Dr Cameron-Strange.’
‘Yes.’
He was hoarse, and barely audible. He did not shake my hand. It was like speaking to somebody through a thick plate glass window.
‘What troubles you tonight?’
He glanced at the chart and back at me. There was a long pause.
‘Addiction.’
I was impatient with the pauses. I didn’t have time for the pauses.
‘And to what are you addicted? Sex? Drugs? Rock’n Roll?’ I rolled my eyes in the direction of the university campus. It was a stupid thing to say, a hangover from the epiglottitis case. Euphoria. Adrenaline.
He didn’t smile.
‘No.’
He was so monosyllabic that my imagination began to fill in the gaps. Studied at Durham. Social Sciences. Plays the Northumberland pipes. ‘Cigarettes? Alcohol? Gambling?’
‘No.’
‘What then?’
He stared at me fully for one minute without speaking.
‘Crosswords.’
I stared back at him.
‘Crosswords?’
‘Yes.’
I gave out a single yelp of laughter. I couldn’t help it. Actually, I wasn’t entirely unsympathetic. I’m a bit of a crossword addict myself. Still, I didn’t make much of an effort to conceal a sense of hilarity.
‘Crosswords. Ahem!’ I was already rehearsing the anecdote for my colleagues in Edinburgh next week. You wouldn’t believe this guy I came across on Friday night …
‘What’s your job, Mr Bletchley?’
‘Cruciverbalist.’
‘You’re a compiler?’
‘Yes.’
He always gave a one word answer, like the solution to a cryptic clue. I had a notion that there was a great avalanche of words all pent up inside him, yet he only dared discharge one at a time, otherwise he would start screaming.
‘Are you professional?’
‘Semi.’
‘Well, if you can get paid for it, maybe it’s not such a bad addiction.’
It was not a question, so he chose not to answer it. I began to nurse an ambition to put him into a more expansive mood. Perhaps if my questions were more open-ended.
‘What is it you are looking for tonight?’
Another long pause. It was surely a manifestation of major depression, this retardation of thought – the inertia, the agony of the effort to move through the slough of despond.
‘Help.’
‘Why do you need help?’
He was struggling. His features were twitching. In a moment he was going to start weeping. I began to regret that I had been off-hand with him. I repeated my question.
‘Why do you need help?’
He shrugged.
‘It’s the bottom line.’
After all the monosyllables, it was like a torrent. The trick of good psychiatry is to distinguish the real from the sham. I don’t claim to be any good at it but, looking into these frightened eyes, I thought, this man is at the end of his tether.
I picked up the ED chart and rose and excused myself.
‘I’ll see if I can get you some help.’
I found a phone and with some difficulty tracked down a liaison psychiatrist and tried to make a referral. In Middlemore Hospital in South Auckland I had good rapport with a liaison psychiatrist. I knew her and she knew me. I could pick up the phone and say, ‘Sue, I know this is a strange one, but I’ve got this guy here who says he’s addicted to crosswords. Yes, I know. I haven’t got the time, but there is an atmosphere of psychosis in the Gloom Room and I have a sense if he is lost to follow up there will be a crisis.’
But I wasn’t in Middlemore. I was a stranger in a strange hospital. As soon as the phone started ringing out I regretted initiating the call.
‘… llo?’
I had woken somebody up.
I gave the story as succinctly as I could. God knows the details were patchy enough.
‘What?’
I could picture the psychiatrist, struggling between sleep and wakefulness, perhaps making faces of helpless incredulity at his wife, now also awake, wondering if somebody was playing a bad practical joke. I ran the details past him again. The silence down the line spoke volumes. I could imagine him taking the phone receiver from his ear and holding it out at arm’s length and squinting at it as if he were pricing an antique.
‘Who are you?’
I identified myself again, told him I was doing a locum. He then ran off a check list in a tone of suppressed anger.
‘Your patient, has he self-harmed?’
‘No.’
‘Is he a danger to others?’
‘Not that I’m aware of.’
‘Is he suicidal?’
‘Well …’
‘Has he indicated he has a plan?’
‘No.’
‘Does he show first rank features of schizophrenia?’
I said, lamely, ‘The room has an atmosphere of psychosis.’
‘Well, doctor. You’ve diagnosed the room as schizophrenic. What about your patient?’
I could hardly blame him. I relented. ‘You’re quite right. I’ll put in a cold referral.’
‘I see. Now I’m going to tell you what I think of you phoning me up at –’
I saw him glancing at the luminous digits on the bedside clock – ‘five in the morning.’ He went on to give me a piece of his mind and a short sharp dressing down. I took it on the chin.
‘I’m terribly sorry.’ The line was abruptly disconnected. There you go. Bouquets and brickbats. I would just have to make a paper referral to the community mental health people. I hung up and retraced my steps to the Gloom Room.
But the man named Bletchley had departed.
II
Since the death of my wife, just over a year ago now as I write, in a car crash, I admit I have retreated into the life of the mind.
I don’t want to make too much of this. I admit it’s relevant. It pertains. But it is not crucial. Of course, at the time, I completely decompensated. I almost gave up. Two things kept me going. One was my work. After the obligatory compassionate leave I found I could function in a detached robotic kind of way. It lent structure to an otherwise pointless day. The other motivator was Caitlin Roy, my sister-in-law, Mary’s younger sibling. At home in her parents’ place (Gloucestershire – people cross the Irish Sea for work) she annexed herself in her room and lay on the bed in the foetal position, facing the wall. I did not chide her. I did not tell her to pull her socks up. I looked at her and I saw an image of myself. We both had to decide whether to survive, or to go under. Destitute as I was, I was yet oblivious to the extent of the damage and the diminishment wreaked on me. Hadn’t I also turned my face to the wall? I only needed to look at my weekend after the night shift at PMH. I’d got back to my Marchmont flat midmorning. We were having a preternaturally mild winter, and there was a horrible dank fug hanging like a shroud over the whole city. It came off the North Sea. It was called haar. It could last for days, sometimes even weeks. It carried with it a smell of stale hops. I swallowed a tot of Lagavulin and crashed into a heavy sleep right through to six in the evening. Then I’d had a large gin and tonic and breakfasted on tins of tomato soup, ravioli, and pears with condensed milk. Then I’d stared at the TV and fallen asleep in the armchair. On Sunday I’d made a brief sojourn to the corner shop for the Sunday Telegraph and spent most of the day ploughing through its myriad sections the way an idiot savant might read the phone book. Christmas was round the corner but it never crossed my mind to get a tree, to send anybody a card, buy anybody a gift. I just wanted the season and its bad memories out of the way. What of my hobbies and pastimes? I didn’t go flying, I didn’t go for a swim, or a run. The bike was rusting quietly in the shed out the back. I di
dn’t play the piano, I didn’t read a book. I didn’t see anybody. During the entire weekend the phone never rang once. Not even a cold call. I didn’t, couldn’t, listen to any music. I was in limbo, completely cut off from life’s deepest streams. I had no perspective on the extent of my own bewilderment. Yet, when I thought of Caitlin and how badly she had taken it all I became angry and I decided that the game was worth the candle and that we would survive.
Back in Little France I resumed my sullen round, the waiting game of the bereft, ‘going forward’, as they say in the modern jargon, hopeless and yet not entirely devoid of fortitude, staying on the rails, waiting for the light at the end of the tunnel. There was the daily routine, the patients, the research and audit, the clinical meetings, the M & M meetings, the post mortems, figuratively and literally. In my surgical scrubs with the iconography of the stethoscope round the neck I could assume a personality of equanimity, even of light-heartedness. The merry widower.
Sometimes I would slip into the hospital residency, where there was a snooker table, and shoot a few balls. Mostly on my own. It was just a mindless activity that would pass an hour. Sign of a misspent youth. It became a lunchtime routine. I would shore up those parts of the day when my spirits sank with little rituals – crossword, snooker, G and T. The snooker was anodyne. There was something hypnotic about the gentle tap of cue tip on ball and the click of ball on ball. I began to notice, with indifference, that I could build a break, control the cue ball. I notched up my first century break. Privately. I never told anybody.
I forgot all about Alan Bletchley. Whenever I read, say, a thriller, or a detective story (is that what this is, or is this a confession, a statement?) I often wonder at the protagonists’ power of concentration on the matter on hand. Is this acuity of focus a talent of the book’s characters, or merely an editorial device of the author? Why are these people not preoccupied, as I am, with unpaid bills and tax returns, office drudgery, dental appointments, commitments various to close kin, extended family, friends, and the community at large? Why do they not even appear to take toilet stops? What about the inner life, the life of the mind? What book is the central character reading, keeping his place by turning down a page corner? Even if the plot has its subplots, there is a kind of monothematic attentiveness that is certainly missing from my life. I am a living exemplar of John Lennon’s remark that life is what happens to you while you’re busy making other plans. I had no idea that Bletchley was going to turn into a mission. Project Bletchley. He hardly registered with me at all. It took a long time before I realised that I needed to drop everything else and focus on this obsession.
One of the managers grabbed my elbow in the canteen queue at lunch.
‘Going to ELSCOMF?’
My heart sank. I suddenly remembered I was going to ELSCOMF. The vista of an afternoon’s snooker dissolved into the bleak prospect of two hours hunched over a board room table, in committee. ELSCOMF was the ‘Emergency Liaison Steering Committee on Moving Forward’. My boss, Forbes Pearson, damn him, had seconded me on board, only to bugger off himself. I whined and bleated, but to no avail. ‘You’ve got to learn to be political, Alastair. Our corner especially needs to be fought for. If we do not survive as a specialty, none of the other specialties will mourn us. Remember that. So, first rule of emergency medicine polemics: be there at the battle.’ It sounded like ‘presenteeism’ to me. Politicians did it. The first hint of a mini-crisis and they would scuttle back from their Mediterranean villas to Westminster, or, for that matter, Holyrood. I couldn’t be bothered. Wasn’t a political animal. But there it was. I had to go to a ghastly multidisciplinary meeting spearheaded by the managers, with all the paraphernalia of flip charts, breakout groups, delegates ‘reporting back’, and the group ‘going forward’. It had originally been called BPA, this committee. BPA stood for ‘Best Practice Activated’. BPA had started as an ethos, expanded into a philosophy, and was now burgeoning exuberantly, one might even say promiscuously, into a multidisciplinary industry. BPA had evolved into ELSCOMF. And here I was, looking at an agenda so long it might well eat into my evening (eating my tin of ravioli, watching the telly). What was more, we had arranged to meet three times that week, prior to an off-site presentation to the acute services, as it so happened, in the Colin Maclaurin Conference Centre at Clerk Maxwell. In the following week we would come together again for a debrief. Meetings generating meetings.
MacTaggart, the Professor of Neurology, chaired. That in itself was anomalous. He was a caricature consultant, big, bluff, flamboyant, and immensely pompous. He wore immaculate Savile Row suits, a buttonhole, stank of cologne, and he drove a Bentley. Once a week he flew down to his rooms in Wimpole Street where City people, government people, and the wives of captains of industry consulted him with their ME. He told them with enormous charm to get over it and he charged them an even more enormous fee. They were on first name terms with him. ‘Angus told me to stop taking the thyroxine and join a gymnasium!’
I wondered what my erstwhile colleagues in Melbourne, where I worked as a registrar, would think, of an emergency medicine committee being chaired by a specialist from internal medicine. It would be incomprehensible to them. They wouldn’t stand for it. They would tell MacTaggart with imperturbable brash bonhomie to go walkabout. Nah fuckin’ wurries, mate. Here, the idea of emergency department autonomy had never really taken off. Nobody, physician, surgeon, intensivist, was going to relinquish the levers of power. But why on earth would MacTaggart be bothered with the micromanagement of the front of the hospital? His big research interest was in slow viruses, kuru and scrapie and BSE, infections that could take an epoch to incubate. There was something deeply ironic in the fact that this man should wish to, or even be allowed to, influence policy in the management of emergent conditions. The golden decade. At least, paradoxically, he was brisk.
‘Good afternoon ladies and gentlemen. Introductions, down the table if you please. My name is Angus MacTaggart. I am Regius Professor of Neurology and visiting Professor of Neurosciences at the University … Dean of Faculty … special interest in prehospital management of status epilepticus …’ (Aye, right.) The potted Who’s Who extract droned on. I could see people further down the table stiffening, hastily rehearsing their own mini-résumés. Nobody was listening. There were a dozen people round the table. Precisely because I’m not very good at this sort of thing, I resolved to attempt to memorise everybody’s name by a technique of association. A senior surgeon was on MacTaggart’s left, competing in qualification and verbosity. This could take all night. The group had arranged itself instinctively into subsets like sections of an orchestra. Big brass first. I was at the back of the viola section. The lengths of the intros were in proportion to seniority and towards the end became virtually monosyllabic. Let’s see: MacTaggart … braggart. Mr Hargreaves … rolled up sleeves. Leslie Horne blowing his own trumpet, John Worthington worthy, Anne Doctor (Dr Doctor) … Helen Gaskell … Gaskell … gasket … fanny mechanic. Eugene Gawkrodger (what a fantastic name) with his bow tie and puce jacket … empty chair (Forbes – wily Forbes – sends his apologies) … Trish Campbell (tartan skirt – ancient Campbell I think) … Phil Clotworthy (overweight – if the cap fits …) … Henry Bach (gasman, pronounced Baitch, rhymes with aitch, old ’enery). The girl on my right said brightly, ‘I’m Tracy one of the nurses.’
I said ‘Tracy who?’
She blushed. ‘Partridge.’
Ha!
MacTaggart Hargreaves Horne Worthington Doctor Gaskell Gawkrodger Pearson (no show) Campbell Clotworthy Bach Partridge.
I thought of the obscene version of The Twelve Days of Christmas. There was a pause.
Chair looked at me enquiringly.
‘Alastair Cameron-Strange, emergency physician.’
What would my hat-check description be? Angry young man? Maybe just strange.
‘We move to item 1: Mission Statement. Leslie would you talk to this?’
‘Thank you chair.’ Leslie Horne colou
red slightly as he hunched over his brief. ‘We’re here this afternoon to workshop some of the finer detail of the points we will present in plenary later this week, re the moving forward of A & E services in this hosp–’
‘Point of order Mr Chairman.’ It was my own forefinger in the air. MacTaggart knitted his brow in annoyance. ‘Yes what is it Alastair?’
Everybody round the table had a bottle of water and a glass. I pushed my glass into the centre of the table. I thought of Richard Feynman, the great showman, pulling off a stunt at the Challenger Inquiry.
‘Swear box. 20 pence for the A-word. 50p for “A & E”. One pound sterling for “Casualty”. Two pounds for “Cas”.’
‘What are you talking about Alastair?’
‘We are The Department of Emergency Medicine. Or the Emergency Department. Or the ED.’
Mr Hargreaves said, ‘I thought ED stood for erectile dysfunction.’ Everybody laughed. Except me. I said, ‘He who controls the language sets the agenda.’ Maybe I was something of a political animal after all. But nobody paid the slightest attention. MacTaggart resumed wearily. ‘Leslie?’
‘You all got your assignments last week. I hope you’ve had a chance to do some homework over the weekend.’
Assignments? Homework?
Leslie got up and pulled a flip chart into view. ‘We’ll just go round the table and jot down your ideas and then workshop them.’
MacTaggart decided to go in reverse order. I have an idea he was trying to catch me on the hop. I shrugged and pouted in a Gallic way, an existentialist sipping absinthe at Fouquets.
‘Primum non nocere.’ It was off the top of my head.
‘Pardon me?’
‘First do no harm.’
‘Yes I know what it means. It doesn’t seem terribly ambitious.’
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