"And my skin is very wrinkled."
"My - you do fret unnecessarily. I never object to wrinkles."
"I don't like to mention this, but I coughed blood yesterday."
"My people assure me that I have nothing to do with that."
"I think I ought to see my GP."
"You should not believe everything he tells you - GPs have a very biased and prejudiced view of our relationship. Sadly, I begin to feel that we are growing apart. However I am delighted that, through you, I have got to know your children. I expect that they and I will remain close and I shall hear about you through them."
"Is this nearly the end of our road together - after all these years?"
"Perhaps it is the end of yours - but I intend to carry on. How old did you say your grandchildren are? I believe I may have met some of them already. Meanwhile my friend, now you need me more than ever- light up and finish the packet."
GRANPOP - ALEXANDER BATTERSBY
Most of this first book section is medical – my Glaswegian grandfather was a compositor, but his son became a doctor, so I have stretched things to include Granpop here.
All Grandparents should be special, but Granpop was out of the ordinary. Domestic jokesters, children-up-in dates, and judicial humorists were lumped together by Gilbert's Mikado as “nuisances who never would be missed”. I beg to differ. My grandfather Alexander Battersby was a passionate talker and games player who never really grew up. In a silent self-contained railway compartment he would provide the spark and interest which started everyone talking and, on a long journey, he would organise a game or two. Years after he and my grandmother had died, people would remember and ask about him.
From holidays, he sent postcards home with characters such as fat seaside ladies and trampled little husbands clearly identified and labelled with family names. A compositor in his youth, he was fascinated by words and spelling, and for his job he even needed an ability to spell in mirror image. Puns were a part of his stock-in-trade.
Alexander could create a game from very slight ingredients - a table in a room, books as bats, other books to make a net, one table tennis ball, and with these a tournament could commence. If a pack of card was available a game of "Ping" was almost inevitable.
Previously an international draughts player, when he was old and I was very small we crossed Glasgow on its miniature tube train to a social club he sometimes visited. On a previous visit he had been quite upset that without any warning they had brought the current Glasgow draughts champion to play him. But despite advancing years and no preparation, Granpop was the victor.
Although a domestic jokester, a humorist and perhaps throughout a long life a child-up-in-dates, Alexander was a remarkable character. The ability to start people talking and make friends with each other is a most enviable talent. I hope that some of these special genes may even have come down to me.
By all accounts religiose to a fault in early life, by the time I came along my grandfather’s passion for games outweighed almost all other factors, and he was a most splendid elderly relative for a small, timid, only-child grandson.
HAMPSTEAD SORROWS - CYCLOTHYMIA
Over coffee in a ward office Sister told me her story. This is not quite her history, but an imaginary letter based on her troubles.
Dear Margaret,
I do hope you won’t mind me writing to you and getting some things off my chest. We sent a round-robin at Christmas but it concealed troubles than shared real news. A year ago you advised me against being swept off my feet straight into marriage, but I thought you were just jealous or a spoil-sport. How wrong I was! But William was such super fun, energetic, lively, loving – oh so loving! – and I was sure we would make the most wonderful marriage.
But alarmingly after a few glorious weeks the bounce and energy drained away from William. It happened quite quickly and instead of being carried along on a torrent of love, ideas, surprises and presents, I found that I had to provide all the support and push and chivvy him along. He seemed deflated, and he stopped sleeping properly. I sometimes found him sitting with his head in his hands when I got home after shopping or work, and there might be a programme playing on the radio which he hated but lacked the energy to switch it off. And when I asked his mother, she looked rather shifty and said – “Yes, he had been rather low from time to time.”, but then she brightly added she was sure a lovely wife would be the answer! She claimed in the past that he had simply got better after a few weeks. And I could not get him to go to the doctor.
I even wondered about drugs, but there was no sign of them, and just sitting at home he could scarcely have access to any. At one stage I had to bully him into shaving and insist that he wash his hair. He was almost like a teenager, and more or less stopped eating. He wasn’t particularly bad-tempered, just slow and miserable.
As you can imagine I was distraught, and began to feel low, lacked energy and slept badly myself especially with William awake and restless in the bed or moping downstairs. The doctor prescribed something for me, but said that he could not give anything for my husband without seeing him, and the one thing William was definite about was refusing to see my doctor or any other. He stopped working but the family firm went on paying his salary.
This happened early last year, and then quite suddenly he began to improve. I first noticed it when he shaved and went out for a haircut and you can imagine my relief. Soon I stopped my tablets and we began to live again as man and wife. We booked a holiday, and I arranged to take leave from work in the summer.
But before the holiday came one day he announced that it was not good enough for me and he had booked a cruise on the Queen Elizabeth. “How can we pay for that?” I asked. “Oh, don’t worry your beautiful little head about that”, he said and like a fool I accepted his reassurance. Then a few weeks before we were due to go I came home and found William looking very pleased and a little wild-eyed. “I’ve invited some friends tonight for supper and the Harrods’ catering team is coming in.” As I looked at him in astonishment, he said “And there is another little surprise coming for you!”
And so there was, for within a few minutes not one, but two Rolls Royces stood outside the door, with uniformed drivers asking for a signature! When I went in to speak to William, he was telephoning British Airways and ordering seats for a Concorde flight the next day for us and for Lawrence Olivier. And when I tried to cut off the phone he became very horrid.
The doctor came, and William was removed. To my astonishment he seemed to know the men who came for him. “Hello again – to the chateau!” he said, and I spent the evening getting rid of two Rolls Royces and various distinguished guests. We even had a minor film star arrive for supper whom I had to send away. Then of course there were demands for payments, some of which I could bat away. I settled others for small amounts, but it was an enormous worry. And when I went to visit William he was in high spirits – thought it all a great joke.
Anyway that episode settled, and since then we’ve not endured any swings of mood quite so extreme. When he’s at a normal level, our marriage is pretty good but I cannot forget I’m living on the slopes of a volcano which threatens to erupt every few months. When he’s moderately high he talks about having lots of children, and when he’s low the world is so awful that it would be criminal to bear a baby, while I can’t help feeling that any child might have the same problems.
So I wanted to tell you about our life and ask for advice. Now that I know William and his family better, I find he had been in hospital five times for similar episodes, mostly when high but once when very depressed after poisoning himself. He had previous girls, but no relationship survived his lurches into illness. And the family (they think I should be flattered by this), thought being anchored to me as a wife in would provide a cure. That is what they say, but I suspect they really wanted prime responsibility for William lifted from their shoulders. So I fear they avoided mention of his illness when we first fell in love, and stron
gly encouraged William and me to have a whirlwind romance and to get married immediately.
Much of the time I like William and even love him still, but if we stay together I see dreadful times ahead. His close family, which includes several noted psychiatrists who should have known better, and more or less threw me into bed and matrimony to take over care and responsibility for his behaviour.
So I thought of you, Margaret, a close old school friend and a rising lawyer. Can I or should I sue the family? They knew, or should have known, that they had a seriously manic-depressive member. I think they conspired to catch me like an unsuspecting butterfly, in their net. And I’m not simply prepared to flutter ineffectively. I know about “caveat emptor”, but surely they had a responsibility to warn me? I fear that it may be them, or me, or William! So for old time’s sake please advise me.
And soon please, – I think he’s getting high again.
With love, Jane.
IN PRAISE OF HOME VISITS
(Or Carry on Consulting. Medicine on the Hoof)
Home visits are always interesting both for General Practitioners and Hospital Consultants. Sometimes an Alsatian dog greets the visitor, or a lady begins to undress before it is clear whether her caller is the doctor or the meter-reader. There may be other unexpected hazards. A colleague (Basil Miles) visited the dowager in her stately home. Her symptoms led him to examine her abdomen as she lay in a huge feather bed. Folds of flab rolled and quivered as he carefully felt for liver or spleen. Then he slid his hand to the far side and suffered a sharp bite from a small bad-tempered aristocratic dog lurking beyond the fatty mounds. Inspect well before you press the flesh!
Most patients are very trusting and leave the door open when expecting a visit. General Practitioner Frank Brown was knowledgeable about horses and racing. As he approached a house in Tupsley one day his watch showed that the Grand National was due to start. He knocked on the door - no reply. He knocked again, tried the handle, found the door was open and went upstairs. One room had curtains drawn, and inside he saw a man in bed asleep. A television set stood in the corner. Frank wakened the man, asked him if they might watch the race first, and switched on the television. The man sat up in bed and both watched until the Grand National was finished. Then Frank switched off the television, expressed thanks and asked “What is the matter with you?” “Nothing” replied the man in surprise. “Why are you in bed?” “I work night shift.” And then Frank realised that he was speaking to a complete stranger and had come to the wrong address!
Alfred, another GP, was straight-laced and devout. One day no-one replied when he knocked on a door, so he went straight upstairs to his patient to find her in bed with another but unrelated patient from his practice. The visitor turned his bare back, and an embarrassed Alfred completed his examination and consultation in an uncomfortable and somewhat strained atmosphere. Both removed themselves from his list.
Hospital Paediatrician Hugh Fisher often visited farmhouses to see sick children. One day in Mid-Wales shortly before Christmas the parent, a farmer, was effusive in his thanks, dropped his voice he added “I’ve put something in the car for you, Doctor, beside your fishing rods.” Hugh saw a large parcel on the back seat and thought of chickens, pheasants, or perhaps a leg of pork. Out of sight, he stopped the car and unwrapped several layers of paper to reveal three large turnips. As everyone emphasises “It is the thought that counts” but he felt a slight tinge of disappointment.
I used to insist on expelling relatives and friends from the room when visiting patients, after a classic encounter with an unstoppably talkative Welshman. Prompted by admiring relatives during any brief moment when he stopped to draw breath, he sat by the fireside and poured forth a detailed, entertaining, and totally irrelevant monologue about his life, times, family, and philosophy before even beginning to answering my questions. I think he must have been a teacher since well trained teachers know how to stretch one single fact to fill a school period, and many seem to have forgotten that straight questions are often best answered by a single word. Welsh people seem to blossom with an audience.
Once I was asked to visit an old lady urgently because she was acutely ill, needed my assessment at home and a clinic appointment would not be possible. I arrived at her house but the door was locked with no reply. Perhaps I had the wrong address? I left to check (this was before the days of mobile phones) and returned when I had confirmed the address. As her house came within sight, I saw a trim figure, well coated and bonneted, carrying a shopping bag and unlocking the door. She entered the house and re-emerged to sweep the front garden path with reassuring vigour. It is generally a good sign when critically ill patients feel well enough to shop and to be house-proud.
Old mansions can be sadly run down and decayed, like some of their owners. One county mansion contained a highly upper-class and superior-sounding lady with troublesome asthma. I had seen her previously when she had denied any unusual dust or mould or decay at home, but for this I only had her word. After a severe episode of asthma, her lady GP asked me to visit the patient at home and together we entered a large, cool, dank, musty bedroom. The windowsills were rotting and dust lay everywhere. It looked like a paradise for house dust mites. I cannot remember exactly why but I opened the door of an enormous cupboard and stepped to one side as an avalanche of old clothes poured onto the floor. The ensuing dust cloud almost blotted out all sight of the patient, and my colleague nearly choked biting back her laughter. So much for the honesty and accuracy of some descriptions which patients give!
Older houses had their electrical problems. My electrocardiograph used batteries, but was prone to pick up fifty-cycle hum or interference from ancient electrical wiring. The most effective cure was to switch off all electricity at the mains, and work by torchlight. It was surprising how many people had no idea where their electrical master switch was hidden.
Visits with colleagues were sometimes delicate. One GP used to terrify me by racing his battered Land-Rover round narrow mountain lanes. Another used to seek a second opinion simply to add weight to his own - “I’ve brought Dr. X to confirm my diagnosis.” Most genuinely sought an extra opinion, and after seeing the patient in his or her home we would repair to the bathroom to wash our hands, discuss the problem, and decide how it should be explained and handled.
A surgeon friend visited a convent in the days before recycling became fashionable. While Mother Superior accompanied him through the kitchen garden he enquired about a nun he had previously treated. “She’s there now.” said Mother Superior, pointing to the presumably consecrated and productive vegetable patch.
A huge echoing house in Credenhill used to be full of schizophrenic Poles, many of whom spoke little or no English. Most Poles from the Second World War either returned to Poland after a few years, or settled and assimilated in Britain. The Credenhill colony of Poles who had unfortunately done neither was brought together from all over Britain. But the big old house could scarcely afford any heating or lighting. One winter evening the Polish warden greeted me in the darkened hall and as we spoke, tiny figures darted out from the gloom and scuttled away while I felt like Snow White towering over her dwarves. Upstairs a large, shaggy, elderly man lay in his night-shirt in a bitterly cold room. He had severe pneumonia and needed prompt admission to the warmth, food, light, comfort and treatment of hospital.
Concentration of problems in one place may seem logical, but has disadvantages. Pump Piece in Leominster used to gather problem families. I visited one man with chest pain. The street contained broken prams, snotty-nosed mucky children ran about, while slatternly women rested big bosoms on gateposts. I found the house and went inside. It was profoundly filthy, and my patient, a man of about thirty, lay between grimy sheets in a dirty smoky bedroom. The number of his offspring approached double figures, and despite his youth he had suffered a coronary thrombosis. It is the only house I felt I ought to clean before entering. I doubt whether the neighbours there helped each other much.
Smaller groups of council houses could also cause problems. I parked unwisely at Moccas and returned to the car to find it surrounded by a small crowd of children which included a little girl waving my car aerial, having torn it off my Metro. I reproached her and her parents, but gained the impression that any car in that street was regarded as honest booty.
A visit can be so engrossing that one forgets mundane things. An older doctor, admittedly a trifle forgetful, drove from Hereford to Bucknell in Shropshire to see a patient. His wife accompanied him and walked into the village to visit the shop and post office. He completed his consultation and drove back to Hereford. Once home, his extremely irate wife telephoned to complain that he had not only left her behind at Bucknell, but that he had politely lifted his hat to her when she waved as he drove past in the lane from the patient’s house. His gracious gesture had made her even crosser.
It is a great privilege to see into people’s houses - sometimes fun, sometimes upsetting, and very rarely dull.
LETTER FOR A FRIEND
The professor read at his library desk. The room was quiet and his gold-rimmed glasses glinted in a shaft of evening sun. He was well-dressed, apart from carpet slippers. After a gentle knock the door opened, and a little grey wispy lady of indeterminate age shuffled forward. She coughed timidly and the professor turned round.
“Come in, come in, Mrs O’Donnell. I should like to discuss your writings with you. Please sit down and we can peruse them together”
“Certainly, Professor - Oh thank you, Professor. What do you think, Professor?” As she twittered Judy O’Donnell perched on a chair. The professor picked up the sheaf of hand-written papers. He tapped it with his fountain pen.