Click, Double-Click

by James Calum Campbell

  Ever since the man with the white face and the black cape had sat briefly behind me in the Slingsby, for the rumble seat ride, I was being watched. I had this vague awareness of a third party, mixed up with a jumble of disparate images – Christ’s walk to Emmaus, Shackleton’s trek across a frozen southern wasteland, something to do with an ordeal, a supreme trial of strength and endurance. Men on a forced march, men at the end of their tether, begin to hallucinate the presence of an extra individual.

  The passenger door opened abruptly and Whangie Horton slid into the seat beside me. She had put on a pair of sandals but hadn’t bothered with a coat or jacket. She must have slipped out of the back door and come round by the side lane. She paused to get her breath back.

  ‘What the hell was all that about?’

  ‘I just wanted to let your father know something he doesn’t want to hear.’

  ‘Hah!’ She raised her eyes heavenwards and then shook her head to indicate the futility of my expedition. The golden hair danced again about her shoulders and I wondered if this was really why I’d come to Ann Street. She had that gregarious openness and ease of communication which for her boyfriends would be a lure and an enchantment and then, when they realised she remained open to the world, a heartache.

  ‘I’ve seen you before. You were in the restaurant in Stockbridge, with your girlfriend. She’s very cute.’

  ‘She’s not my girlfriend. She’s my PA.’

  ‘I suppose that’s better than saying she’s your niece. She didn’t seem that interested in the Monty Hall problem.’

  ‘You must have excellent hearing.’

  ‘I’ve never got it, myself. Dumyat has tried to explain it.’

  ‘Did you get the Möbius strip idea from him too?’

  ‘You’re stalking me.’ The idea amused her.

  Extraordinary, the way somebody can explode into your life. A silhouette at another table, a name, a low voice, a gait, a public persona, a few words of casual conversation … at what point do you realise that something is happening, has already happened? We spoke as if we had taken up a conversation that we had left off before. I could see it was a powerful weapon of hers, this sudden intimacy. Look, let us be done with the social niceties. These piercing blue eyes stared intently at me. Perhaps she used them chiefly as a means of defence. Most men would evade them, would avert their gaze and indulge in small talk and imagine they would not have a faint heart on the next occasion.

  ‘I have to say, you were great with the kids. You reminded me of somebody I used to know. And incidentally, when you smile, you have beautiful dimples.’ I reached over and caressed her cheek. I dropped my eyes to the deep cleavage of her breasts and then to the tanned thighs where the brown dress had ridden high above her knees. It was just impossible for her to disguise her body. I wondered what it must be like to live within such a frame, to walk through life forever conscious of the evasive hunger in men’s eyes, and the cold flat appraising look of other women. What a curse to be blessed with such a body. Never to be able to get away from it, to turn it off, to shut it down. Maybe that was why she needed the sanctuary of a church, to escape from the gauche advances, the awkward fumbling. Yet it might prove a heady brew for some, this clash of the spiritual and the carnal. Whatever turmoil she might cause in others, she had a quiet serenity, the inner certainty of someone who knows she will never walk alone.

  And yet even now a part of me remained immune. Maybe that was why she felt comfortable to sit with me in the car. She probably guessed I was in love with a ghost. She could feel perfectly safe. It crossed my mind to start a relationship with her solely in order to torment her father.

  But I decided not to hit on Whangie. Quite the opposite. I would kill the notion stone dead. I would do this by explaining the Monty Hall problem to her. Can you imagine any less flirtatious exposition? Winston – hardly the world’s greatest flirt – used to go to dinner parties and totally ignore pretty young women seated at his elbow. One of them gave him a nudge when he was lost in abstraction and said, ‘What are you thinking about?’

  ‘I am thinking of a diagram.’

  There’s a chat-up line for you.

  ‘The thing about Monty Hall – it’s basically an exercise in Bayesian statistics. Think Game Theory. Think Johnnie Von Neumann. What’s the other guy gonna do?’

  Abruptly Whangie swung round and pushed herself between me and the steering wheel.

  ‘Push your seat back.’

  I scrabbled for the levers. The seat shot back and tilted into the reclined position. The hot breath and the weight of her body were on top of me. She grabbed my hand and pulled it between her legs.

  ‘Quick.’

  Afterwards – (after what? I’m not even quite sure what) – I wondered what on earth had prompted such a brazen advance. Was I irresistible? More likely she was turned on by the unprecedented sight of somebody antagonising her father. Or did she just crave the excitement of having relations in a public place?

  After we had resumed our seats and readjusted our clothing, she gave a smile, a sigh, and then a mirthful giggle.

  ‘You’re not quite the anorak you purport to be.’

  And then, rather shyly, ‘Are you Anne Strange’s twin?’

  So that’s it! She fancies my sister. Fame by association. The female sex – they like to think they are free agents. But there always seems to be some other item on the agenda that has nothing to do with the wind that bloweth as it listeth, and everything to do with society, status, fame, power, and wealth. But it was strange to me, the way she enquired about MacKenzie. Clearly my sister’s fame extended well beyond the rather closeted confines of chamber music. It was perhaps the first time in my life that I sensed that I might be related to a superstar.

  XVII

  At the reconvening of ELSCOMF, I finally lost the plot. It started when a girl from upstairs began her PowerPoint presentation with an algorithm illegible from the front let alone the back of the room.

  ‘I apologise for this busy slide …’

  ‘Well bloody don’t! Just get it off.’

  That was me. I bit my lip. She carried on. The ghastly plot unfolded. Upstairs wanted to introduce a system of electronic communication between the emergency department and the in-patient services. It was called LIAISON. LIAISON stood for Live Intranet Access into Strategic Online Nexus. Oh, a phone call was fine. It’s good to chat. But apparently we needed something a bit more hard-wired. It left an audit trail. Performance would therefore be measurable. Effective interfacing could therefore be evidence-based. LIAISON was integral, going forward. LIAISON was patient-focused. LIAISON was indispensable to patient safety. LIAISON was a KPI.

  So. It was happening, before our very eyes. We had gone paper light and there had been no resistance. No Fahrenheit 451. Who was it that said that after you burned books, you would burn people? I had been naïve to suppose that these people were merely opposed to the destruction of trees. It wasn’t paper these people wanted to ban. It was language.

  The girl from upstairs wittered on. It was scary the extent to which this project had already advanced. It was naïve – again – to suppose that think tanks like this composed their LIAISONs, their clumsy acronyms, as an academic exercise. LIAISON was fast becoming a reality even before its diabolic machinations had been unfolded. Here it was – the what the who the how the when the which the whence the wherefore … it was being rolled out. Stakeholders had to be kept in the loop.

  The deadly dull minutiae of the system’s working were paraded before us. Click here … select from the drop-down menu … tick the box … fill in this compulsory field otherwise you can’t proceed … marvel at the way the patient’s data, the complete life history, is automatically retrieved … free text here for those who want it (not compulsory) … and … double-click to submit! She signed off with a triumphant gesture.

  Any questions?

  I found myself on my feet. I hadn’t rehearsed my question. It was an odd, out-of-body experi
ence, like hearing another member of the audience.

  ‘You have mentioned the what, the who, the when, etc, but what you haven’t done is mention the why.’

  She blinked at me superciliously.

  ‘My question is, why bother? Why liaison? Why would you want to displace a conversation in favour of a drop-down menu? We have this marvellous gift. I mean language. It has evolved with us over millennia. In English it has found one of its most expressive forms. English is capable of great subtlety, great differentiation, niceness of meaning, and of course great expressive power. Why on earth would you want to replace all that with a form and a series of tick boxes? What on earth is the point?’

  Her answer was a regurgitation of the earlier part of her talk. I must admit I wasn’t really listening. Audit trail … evidence-base … patient-focus … patient safety … KPI … measurable targets …

  ‘Oh for God’s sake! We don’t need to put up with this. Why are we allowing management to dictate the way in which we practise? The managers don’t know the first thing about medicine – and why should they? It’s time the medical profession put its foot down. We need to take a stand. We could start right here. Right now.’ My forefinger, unbidden, was making stabbing gestures in the air. I hadn’t planned to do this. It just ran away with me.

  ‘Why are we all so infatuated with IT? Why is it that, just because a technology exists, we feel compelled to utilise it? I’m not opposed to computer technology. It can be very useful. It has a place. But it needs to subserve our core business, not supplant it. But look what’s happened. Everybody’s spending their entire day hunched over a computer screen. Clickety clackety click! We have neglected our craft. People who peddle IT in medicine are always going on about patient focus. The best way in my experience to focus on the patient is to turn the desktop off. We need simplicity. We need a return to basics. We need to restore the sanctity of the consultation. History and examination. That is what we do, in the emergency department, more than anywhere. We consult. And when we need the help and expertise of our colleagues, we talk to them. I propose that LIAISON be nipped in the bud right now. Drop it. Bin it.’

  I sat down. There was an awkward silence. No applause. No ‘hear hear’. I heard the restrained sound of somebody coughing into a fist.

  MacTaggart said, ‘Thus spake the Tolpuddle martyr.’ There was a burst of loud laughter as if a pressure valve had been released. MacTaggart let it die down and then addressed me confidentially across the table, with pained indulgence.

  ‘It’s coming, Alastair. No point in trying to turn back a tidal wave. Not unless you want to keep Casualty in the dark ages.’

  ‘What the hell do you mean by that?’

  I felt a hush descend upon the board room.

  MacTaggart turned down the corners of his mouth. ‘I only mean what I say, Alastair. It’s hardly rocket science. Moving along …’

  ‘Maybe I’m too stupid. Spell it out for me.’

  ‘Very well. We are merely trying to get you and your colleagues down at the coal face where, let’s face it, you’re struggling, to move into the twenty-first century. You should be grateful. We’re trying to help you.’

  ‘Well if you really want to help, give us more doctors and nurses – “down at the coal face”, as you put it. At the end of the day it’s perfectly simple. Patients turn up at the front door, and we should be there to care for them. Invest in that – not this … sterile nonsense.’

  ‘Alastair, we’ve been over this before. If ELSCOMF achieved one thing at the Maclaurin Conference Centre last week, it was the consensus that we need to drive 40% of the patient load back into General Practice. Compassion is very commendable, but a tertiary institution like ours, with an international reputation in research, in state-of-the-art technology, cannot afford to mire itself in the daily grind of the needy and inadequate. I’ve seen it all before; open the doors and you will be inundated. It doesn’t matter how many doctors you have down there – it’s a bottomless pit. I told you – the poor ye will always have. You might spend the next thirty years down there – I have a horrible feeling you are going to – and at the end of it, everything will be exactly the same. Keep it as a training ground for the juniors.’

  ‘That says it all. You’re not the solution. You’re the problem.’

  ‘I beg your pardon?’

  ‘How dare you impugn the Emergency Department with a charge of backwardness? You have taken pains to ensure that the department is disempowered, disenfranchised, understaffed, underfunded, the fiefdom of a bunch of absentee landlords who wouldn’t be seen dead in the place and who haven’t dealt with an emergency for twenty years. You have no idea what goes on in a modern emergency department.’

  Then it got personal.

  ‘You come in here, with your airs and graces and your insufferable pomposity and you dare to talk to me about “Dark Ages”? If anybody’s obsolete round here it’s you! Casualty! What the hell is that? Have you any idea how prehistoric you sound? Spew up this garbage in any other part of the English-speaking world and you would be a laughing stock! You’re ridiculous anyway. You smug, effete, bloody Regency fop! You’re irrelevant, and you don’t even know it. And look at your idea of help. Look at this junk, this hapless rubbish! What do you people know about medicine, and humanity, with your useless, sterile, clunky, tick-boxy, dropdowny, crappy, cruddy …’

  The red mist had descended. I welcomed it. I believe I was hoarse and weeping. What a blessed relief. Forbes had slipped in and quietly appeared at my side and had an arm round my shoulder.

  ‘Let’s go for a cup of tea, old chap. Come on.’

  He led me out of the boardroom. My exit came straight out of Opera Buffa. As he pushed the door open somebody heckled from the committee.

  ‘Luddite.’

  I yelled back. ‘I am not a Ludd–’

  The door slammed.

  That night, I had a blazing row with Caitlin. Back in the desolate flat with its dank subliminal aroma of inoccupation, I poured myself another glass of Lagavulin.

  ‘What did you think of the Bax Quartet the other night? Did you enjoy the concert?’

  ‘No. Can I have one of these?’

  ‘Wouldn’t you rather have some cocoa?’

  She ignored the question and poured herself about three fingers.

  ‘Steady. Put some water in that.’

  She didn’t. She sipped it appreciatively. ‘Nice drop.’

  ‘I thought maybe the music would inspire you to get out your oboe.’

  ‘Yeah. Well I tell you what, I’ll get out my oboe when you take that layer of dust off your piano lid.’ She was always merciless in the counterattack. I should have let it go, and to be honest I didn’t really have the heart to pursue it. I was just being dogged.

  ‘Caitlin. You’re going to have to make plans. What are you going to do? What are you going to be?’

  ‘I thought I might get pregnant then I could get a council house in Pilton.’

  ‘Attagirl. Don’t let anybody piss on your dreams.’

  ‘Tread softly.’ She threw the rest of the Lagavulin back in one gulp.

  ‘Caitlin get a grip. You’ve got your problems. Don’t you think I know that? But you can’t solve them hiding away in a flat in Marchmont. I can help you, but not like this. Go home. Go back to school. Get back to a semblance of normality, even if you don’t feel like it.’

  ‘Smile though your heart is breaking?’

  ‘Something like that. Because if you don’t, I tell you what, it’ll destroy you. It all seems a helluva blast to you just now, the cigarettes and the whisky and the attitude, but trust me, in no time at all you’ll turn into an ugly middle-aged alcoholic slag.’

  She laughed at me incredulously. ‘So throw me out.’

  ‘Go to bed.’

  Caitlin took three steps up to me, put an arm round my neck and gave me a big wet malty kiss on the lips. Then she stepped through her bedroom door and slammed it shut.

  XVIII
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  She didn’t appear for breakfast. I sat on my own reading the paper. The usual pile of junk mail flopped through the letter box. I shovelled it up for immediate transit to the recycle bin, scanning for bills, adding a couple of unopened Christmas cards to the neglected pile I was accumulating.

  Somebody had written me a letter. How unusual to see the handwritten name and address on the sealed blue envelope. I opened it with curiosity.

  5 Willow Grove

  Kingseat

  Dec 18th.

  Dear Dr Cameron-Strange,

  I hope you don’t mind my writing to you personally. I believe you were seeking the whereabouts of a patient of Mr Trubshaw. His name is Alan Stobo and he lives at East Cottage, Claverton Estate, East Neuk. He is one of the lecturers at the college. His mother is a friend of mine. She has been worried about him and she thanks you for your concern.

  I don’t think he’s on the phone. Best to enter the estate by the west gate house and follow the drive, keeping left. Mind the potholes.

  Yours sincerely,

  Elspeth Mayhew (one of the cleaners at the hospital)

  The letter had been written neatly in a female hand that had lost its youthful curves. The spelling and punctuation were meticulous. Nothing reminded me more sharply than that letter of the grotesque upsidedownness of a society whose leadership is characterised by puffed-up pomposity, crass ignorance, and bumbling incompetence; while down in the rank and file, Elspeth Mayhew kept the hospital floors scrupulously clean, had her finger on the pulse, and was a mine of information. And there was I, wasting my time going cap in hand to consultants, lawyers, senior police officers, academicians, and Members of Parliament whose soul preoccupation was in ticking the box that would satisfy their own superiors and progress their ‘careers’. And all the while the information was available, if only I had known who to ask.