Peremptory medicine practised by peremptory doctors. I would never forget that MacTaggart had said something like this to me. I felt a surge of fury, but with it, a dawning surge of hope. A ‘Great Idea’ had suddenly occurred to me. I would take the bastards on. I would take on the combined might of the Royal Colleges. Here was something to get my teeth into. Ever since that calamitous night a year ago I had been paralysed, emasculated, incapable of action. Not now. I had rediscovered my métier. I was once more on a grand crusade. In a flash of insight it became clear to me why MacTaggart chaired ELSCOMF, why he took pains to be present, to take control of the meetings. It was to make sure we stayed in our place. That was why he chose to adopt archaic language. Cas, casualty, A and E … he made our facility sound like a dressing station on the Somme. That was because he wanted it to be so. He wanted the front of the hospital to be trench warfare, chaotic and mangled; a morass of bewildered ‘casualties’ being treated, maltreated, by a bunch of hapless, and peremptory, juniors. The blind leading the blind. From time to time he would send a lieutenant down to rescue one or two carefully selected individuals worthy of salvage. And when things went wrong he would shake his head. ‘Peremptory medicine …’
Perfunctory. That was the word.
Bastard.
Cas … A and E. Who defines the terminology sets the agenda. Here was a place to start. Don’t allow bad language. Don’t let it pass. It would be a modest enough start, but a start. I was going to take them on. I would dig in for the long haul, with Churchillian doggedness. ‘If necessary, for years …’
‘If necessary, alone.’
Back at the flat, over the pre-dinner Gewürz, I asked Caitlin, ‘How are you getting on with the sleazy guy outside the V & A?’
‘Oh that. I decided not to bother. It’s beneath me.’
‘Not to worry. I’ve solved it. It’s LINGUA. Or LINGUAL.’
‘Well which is it?’
‘Both actually. Let me explain.’
‘Must you?’
‘It’s two clues in one. The first clue is, “Mash an ugli, tongue.” Answer: LINGUA. It’s an anagram of “an ugli”. Second clue: “Of tongues, with Lagavulin distilled outwith the V & A.” Answer: LINGUAL. A distillation of Lagavulin but out with letters V and A. See? I think that’s very clever.’
‘I think you’re the saddest person I’ve ever met.’
The trouble with smoking pot is that the cannabinoids stay in your frontal lobes for ever. Twenty four hours later I was still having bad dreams. I was dreaming about Edinburgh New Town, and the gracious octagonal elegance of Moray Place, and then I suddenly flitted to the other octagon, the other Moray Place in the other Edinburgh – Dunedin New Zealand. Then I took a flight along the north shore of Otago Harbour. I didn’t bother taking an aeroplane. In my dream state, it never struck me as odd that I had the power of flight. I landed at a village opposite Taiaroa Head, close to the harbour entrance, in time to see an armed man emerging from a dilapidated cottage, firing from the hip. Then the film froze, and I woke up.
When you get stuck on a crossword, the thing to do is leave it, do something else, and come back later. For no apparent reason, that which was obscure is suddenly glaringly obvious. I picked up Mr Bletchley’s half-complete puzzle and pretty much finished it. After I had done all of the simpler clues I had a look at the four unclued lights.
HOD _ _ E _ T
A _ A _ _ A _ _
_ U _ BLANE
CO _ _ _BI _ E
Then I got stuck into the remainder of the twelve twin clues. Caitlin’s ‘ugli’ clue had been a breakthrough. The redundant letter in this case of course is L. I was beginning to see how these clues worked. Something was beginning to emerge.
HOD _ _E _ T
A _ A _ _A _ _
DU _ BLANE
COLU _ BI _E
That’s one solved: DUNBLANE. Nice town, beautiful cathedral, famous sporting son, golden letter box. Does it help with the other three?
HOD _ _ E _ T
A _ A _ _ AN _
COLU _ BI _ E
There comes a eureka moment in the unravelling of an enigma. I have to say I didn’t think a great deal about it. It just indicated that Mr Bletchley had a mawkish preoccupation with the macabre. Columbine. There it was. The thematic link. What was it?
Notoriety.
And, knowing now what I was looking for, I discovered that I, or at least my unconscious mind, had recognised it already. Maybe a New Zealand background helped. Flickering images salvaged from discarded reels of corrupted celluloid left on the cutting room floor. Something bad had happened deep down in South Island.
ARAMOANA
And something else, across the Tasman.
HODDLEST. Of course.
Hoddle St.
That only left The Bottom Line. I had my twelve assembled letters to unjumble.
ACEEKLLLMRWX
And on the grid – C _ ER _ _ _ _ _ _ LL
I glanced at the clock. 04:00. Not again!
Get some sleep.
Back into Little France, into the blue scrubs, on to the floor, re-enter the world of pain and misery, angst, hope, and despair. Then, worst of all, get along to the Board Room.
‘… coping strategies for bed blocking … Alastair are we keeping you awake?’
‘Sorry, Professor. Rough night.’
I could see by his pained expression that MacTaggart really despaired of me. I suppose with all the cumulative late nights I looked like somebody who slept rough out on the streets. I was down and out amongst the vagrants. And I didn’t mind. I was like Mr Black, alias Mr Green, one of our recidivist tramps who hung around the entrance and occasionally came in for some respite from the cold. I too was a recidivist tramp. The only difference was I was on the pay roll. I knew MacTaggart thought it was an affectation on my part, pretentious, like Schweitzer heading off to a léproserie at Lamberéné. Maybe I had a Messianic Complex, a deeply unhealthy erotic desire to move amongst publicans and sinners in the dark wynds of existence from whence some harlot of low caste would rub nard into my feet with her matted hair. But MacTaggart had dismissed me now, offended by my rebuff. ‘Cameron-Strange? He’s finished. He blew it.’
Quick visit to the snooker table before going home. I set up the balls, colours only, and rehearsed my routine of potting them from their spots. Twenty seven points on the table. I’d reached the stage that I could sink all six balls on automatic pilot more often than not. Tap … click … flop … two … five … nine … fourteen … the chaste kiss of white on pink … twenty and, to make twenty seven … an exhibition shot on the black.
Click.
It’s Clerk Maxwell.
How thick of me not to see it.
The Bottom Line! What did Bletchley say? … thematically related to, and also predicted by four (unclued) lights.
Predicted!
Bloody hell.
VI
I laid my cue down on the deserted baize, took out my battered copy of The Bottom Line and wrote down the solution to the last clue across, to complete the grid. Then I glanced at my watch. Five to five. If I ran back across to ED I might just catch Forbes in his office.
I felt oddly apprehensive when I banged on his door.
‘In!’
MacTaggart was there. Forbes, dapper, twinkling, pleased with life, was putting his coat on. I think they were heading out to some Faculty cheese and wine thing.
‘Something on your mind Alastair?’
‘I’ve got a problem.’
Forbes glanced at the clock. ‘Can it wait? Is it important?’
‘I think it could be.’
Forbes’s eyes flicked in the direction of MacTaggart and back again. I nodded imperceptibly. This was confidential.
‘You go on Angus. I’ll be five minutes.’
And I thought, why don’t I want MacTaggart to know about this? Because I definitely don’t. Forbes waited for the door to close and then gestured wordlessly at the chair. He was irritated. I felt
coy, like a school pupil venturing to show his attempts at verse to his English teacher. I hadn’t rehearsed this.
‘I saw somebody over at PMH who’s planning a Columbine.’ I don’t know why I felt so reticent about voicing my concerns. I suppose it was fear of ridicule. Only an anorak, a nerd, would have taken the trouble to track the puzzle down, let alone solve it. I laid the paper on the desk. Forbes was frowning. I ploughed on. ‘Crossword compiler. I solved one of his puzzles.’ I let Forbes read the legend and study the grid. He didn’t need many pointers. He was very sharp. I indicated with a pencil.
‘Here are the four unclued lights. They predict the bottom line – here.’
Forbes nodded and sniffed to indicate he had taken it in. ‘Student prank, most likely. But an ill-advised one. What was he like?’
‘Very low key.’
‘Well. It’s not a crime to set an acrostic, even when it’s in bad taste. Let it go. Pass it on. Send it up to the liaison psychiatrists with a covering note. Better copy it to Trubshaw as a courtesy.’
‘What if they just file it away?’
Forbes said, with frank exasperation, ‘That’s their business. You are not a detective. You are not a social worker. You are an emergency physician. Always remember there are more people coming through the front door. You haven’t got the time for after-care. It’s not your responsibility. Live with it.’
And that was that.
But over the next few days I found it hard to let it go. The Bottom Line preoccupied me. I gnawed away at it. I didn’t want to, I would have gladly accepted Forbes’s advice and let it go. But somehow it wouldn’t let me go. I would set up the jolly coloured balls on the green baize and try to obliterate The Bottom Line in the simplified world of Newtonian mechanics. Strike the ball thus; pocket the object ball; position the cue ball for the next shot.
I suppose it was inevitable that, in this frame of mind, I would make a mistake. At least I thought it was a mistake, even if my colleagues were quick to back me and say they would have done exactly the same under the circumstances.
A twenty-one-year-old woman, previously well, presented with a headache. She came in around nine o’clock in the evening looking for some analgesia so that she could get a sleep. She was exhausted because ten days previously she had given birth to a baby boy. The physical examination was entirely normal except for one thing. Her blood pressure was high. Not sky high, but high. Had she had high blood pressure during her pregnancy? No. I was taking it in the noisy environment of the emergency department and at first I didn’t get an accurate reading but I registered it was high. I took it a few times and the best I got was 165/90. I recorded this. But why did I record her best BP? Why not the worst? I gave her some codeine and asked her to attend her GP in the morning for a further check of her blood pressure.
She had a bad night with increasing headache and in the morning she chose not to attend her GP but to come back to us, where a colleague recorded a BP of 240/140. She was admitted and treated for hypertensive encephalopathy. She got better. Thank God.
Well, with the benefit of what we call the ‘retrospectoscope’ I would have admitted her. But would I, should I, really have done something different? I was morose for about 48 hours. The usual thing. Get out of acute medicine and go into research where you can’t do any harm. And of course, after a thing like that, you can’t just crawl away into a hole and fester. You keep practising medicine. And more acute conundrums present themselves. That is the difficult bit. But I couldn’t get the young mother out of my head. What if she had had a catastrophic bleed and died? Or ended up in a semi-vegetative state, lying at the bottom of a remote rehab ward being fed through a tube? And what of me? If I get as upset as this with a near miss, can I really contemplate a career in this environment for the next thirty years?
At length Forbes hauled me into his office and gave me some counselling in typical Forbes fashion: ‘You were asked to see a patient. Did you see her? Yes. Did you take a careful history? Yes. Did you undertake a careful physical examination? Yes. Did you reach a rational conclusion? Yes. Did you arrange a suitable disposition? Yes. Did you arrange appropriate follow up? Yes. Would you have done it any differently? No. Toughen up!’
He paused. Then, on another tack: ‘I wonder if you’re working too hard. I know you’ve had a rough time, what with Mary … Forgive me if I’m speaking out of turn, but do you get out much? I hear you’re smoking again. You don’t play music any more. You’re not getting much exercise. You’re not flying.’
And all that was perfectly true. I couldn’t stand music. I hadn’t flown an aircraft for months. I wasn’t current. And after a hard day in the hospital the last thing I wanted to do was go for a run. I’d rather have a large whisky, just to ease my way through that difficult time of day, that time when the day’s commitment receded. The awkward twilight hour. The evening yawns at you.
And as I opened the door on my way out he called after me, ‘Have you closed the file on Mr Bletchley?’
‘No, not yet.’
‘Drop it Alastair.’
VII
I fished the business card of my Medical Defence Union out of my wallet and dialled an Edinburgh number.
‘Cardwell Walkerburn you are speaking with Vikki how may I direct your call?’
‘My name is Dr Cameron-Strange. I am seeking a medicolegal opinion.’
‘I’ll see if Mr Walkerburn is available putting you on hold.’
Hold was, predictably, Vivaldi, and a blizzard of violins. A pause, and then a clip-clop sleigh ride. I found it completely charmless.
Abruptly the music came to a halt and the line went live, like a cold shower.
‘David Walkerburn.’
It was a careful voice.
‘I’m phoning about an issue of confidentiality.’
‘Yes?’
‘It’s rather sensitive. Could I call in at your office?’
‘Would two o’clock suit?’
So. I had set something in motion. Not yet irrevocably. Mr Walkerburn would protect my confidentiality just as, thus far, I had protected Mr Bletchley’s. This thing was still contained.
It was funny how I hadn’t wanted to talk over the phone, just as I had not wanted to have MacTaggart present when I confided in Forbes. Perhaps I thought the line to Cardwell Walkerburn wasn’t secure. But why would that matter? It wasn’t just the confidentiality issue. After all, I could have posted The Bottom Line on the Health Board website much like a public health warning, about a nasty epidemic of norovirus in the community, a faulty batch of pharmaceuticals that was being recalled, or a drug addict doing the rounds of various emergency departments under assumed names. ‘… calls herself Felicity Dunlop, Heather McCready, or Sandra Dunn. Five foot three, short red hair …’ How might I phrase it? ‘Police are in receipt –’ (I was thinking ahead) ‘– of a threat to James Clerk Maxwell University College Campus … students, staff members, and visitors are asked to be on the highest alert and to report any suspicious …’ Yet people would want to know the nature of the threat. What? A crossword? You’re kidding. That was why I didn’t want to fax The Bottom Line across to Cardwell Walkerburn. It was just too silly. I almost phoned Walkerburn back to cancel the appointment. I could get myself out of all this. I had woken up that morning full of an intense homesickness for New Zealand. Maybe it was time to go home.
Forbes had pointed out to me how miserable my life was. You don’t run, you don’t fly … You don’t get much fun. I was anhedonic, as the psychiatrists would say. They always used these daft words that nobody else used. I was anhedonic to the extent that I sometimes even entertained suicidal ideation.
But when I thought of running, and of flying, I thought of New Zealand. They’d be going into summer now. As I walked northwards through the clinging haar down the hill off Princes Street toward 48 Heriot Row I took off in a Cherokee Archer out of Ardmore, just south of Auckland, and flew all the way up to Cape Reinga. Nice smooth landing on the tiny grass stri
p. Cut the engine and enjoy the silence after the hours of engine roar. Listen to the little sounds of nature. Make the plane safe and take a stroll down to Waitiki Landing and say hello to the whanau. Maybe borrow a ute and take it on to the unsealed road at Te Paki station and take a turn down to the big dunes. Here I will kick off my shoes and slosh down Te Paki stream through the dunes to the great expanse of Ninety Mile Beach and the awesome thunderous silence of the ocean.
‘It’s very arcane. And rather oblique. Do you think there’s much in it?’
We were sitting in a dusky back room in the offices of Cardwell Walkerburn, Writers to the Signet, at the west end of Heriot Row. The haar had even found its way in here, curling its way like trench gas around the dusty bookshelves.
I have a deep distrust of the legal profession. I try to keep away from it at all costs. My view of it is Dickensian. I think of scriveners and proctors toiling away with quills at high desks, of Jarndyce and Jarndyce, of endless litigation, suits buried in a morass of legalese in Latin, Mr Jaggers endlessly washing his hands. But I quite took to David Walkerburn. He was a very tall man – six seven I would guess, with a permanent stoop acquired from the endless interaction with all sorts of humankind. He wasn’t a man in a sharp suit. His was a tired three-piece grey pin-stripe which seemed to emphasise his sallow, bookish complexion. He was entirely lacking in razzmatazz. He sat staring at The Bottom Line and biting his lip.
‘What does Professor Pearson think?’
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