Tom Smith - Going Loco: Further Adventures of a Scottish Country Doctor

J immys big blue eyes looked up at me from the couch, worried , near to tears. His big sister, Jenny, at fourteen all of three years older than him, handed me a small grubby piece of card. It was an opened-out cigarette packet. On the outside was that jolly sailor with his head inside the lifebelt the one with Senior Service printed on it, proving to its addicts that if it was good enough for our stalwart sailor lads, it was good enough for us.

That wasnt what interested me. On the plain side, that had been the inside of the packet, there was writing. Not easily decipherable, as it was a doctors, and everyone knows what their writing is like, but eventually I made it out. It was brief and to the point: Dear Doc, Appendicitis? Yrs R Patrick.

Is this all? I asked the girl.

Yis she replied, Brummie accent well to the fore. Will he need an operation? glancing fearfully at Jimmy.

Let me look at him for a minute, and Ill know better. How long has he had the tummy pain? I was at my kindest and least frightening, but I knew the two kids were terrified. As I moved forward to talk to Jimmy, she pushed herself between us, defending him from my attack.

Youre not going to touch him, are you? she asked.

Well, I have to, I said, to find out whats wrong with him.

Dr Patrick doesnt do that. Hes a prescribing doctor, not an examining one, she replied.

You mean he didnt put his hand on Jimmys tummy?

Course not, she said indignantly. He dont have time for stuff like that. Once he knew that Jimmy had stomach pains he sent him here. Its up to you, he said, to find out whats wrong.

Wow, I thought, but I smiled at her.

Well, maybe hes right, I said. I suppose Im the examining doctor, then, not the prescribing one.

She grinned back at me. Thats all right then, she said, but dont hurt im.

I took off my white coat, so that I was in my shirtsleeves, and sat beside Jimmy, our faces level. He had the blue scarf of Birmingham City around his thin neck, to keep him warm. I tugged a little at it, for fun, and smiled again at him.

Im a Villa man myself, I told him. You dont mind one of the enemy examining you?

He smiled. So the doctor was human. Divested of my uniform, I must have been a lot less scary.

So how long have you had the pain? I asked again.

A few days, he replied. I think its because I havent been. Its cold in the dunny and I dont like going out to it.

Light was dawning. It was February; we were in one of the coldest winters Birmingham had ever known. The frost had penetrated so far through the ground that the water mains had frozen and water was being delivered by truck. Jimmys house was one of thousands with no inside toilets and the journey out to a cold dunny had been too much for the lad. He didnt have a scrap of fat to keep him warm and his clothes were threadbare.

Can I feel your tummy? I asked him.

He nodded. I unbuttoned his jacket, he rolled up his jersey, and I opened his shirt. Underneath he had a vest, and under that was a sheet of thick brown paper tucked around his chest and waist like a tube. I had seen that before brown paper had a great reputation for keeping children free of chills. Finally, I got to his skin.

I gently laid my right hand on his flat stomach.

Where is the pain? I asked him. If you can, point to where it is with just one finger.

Jimmys shaky right index finger positioned itself over the lower left side, just above the groin.

I think you are right, Jimmy, I said. You havent been for a while, have you?

It was an easy diagnosis. He had about a weeks worth of constipation in his gut, and being small and thin, he was bound to find that pretty painful. I straightened up and smiled at both children.

Well just help you a little, I said, and you can go home. Dont worry.

I arranged for a gentle enema for Jimmy, and a cup of hot tea and buns from the canteen for both of them while sister, in the background, tried to find out why their parents werent with them. Dad was at work, and Mum had seven other children to look after. Jenny, the oldest, had taken the role of carer for the visit to hospital. They had come in by bus, straight from the doctors surgery.

I looked at the cigarette packet again. I took my biro from my white coat pocket, scored out appendicitis, and replaced it with constip. I wrote yrs T Smith underneath, and gave it to the waiting hospital car driver. These two werent going home by bus if I could help it. They would be driven in style, after eating and drinking their fill. The driver would deliver the note to Dr Patricks surgery a few doors along from their home.

Later, relaxing in the mess over coffee with other duty housemen, I brought up the subject of Dr Patrick. His single-handed practice was famous, but not for the right reasons. For years now he had been sending in messages like this, without the courtesy of phoning beforehand. He didnt seem to care when a consultant blasted him out for wasting the hospitals time. And no one could remember when the old guy had made a correct diagnosis.

I wasnt sure about that. Obviously, it was a big mistake to mix up constipation with appendicitis and he hadnt even felt the childs abdomen. But Jimmy had needed our attention, so I was glad that Dr Patrick had sent him in. Give him his due, he had served his time some said more than 40 years in the poorest district of the city. He deserved brownie points for that.

Manu Tailor, a long-time friend as a student and now a fellow houseman, had been reading the noticeboard.

Hey, Tom, he called across the room, you get Saturday off next week dont you?

Yes, I replied, but I have plans for it.

Like sleeping all day? laughed Manu. With one day off every three weeks, we usually spent it catching up on lost sleep. What about doing a locum instead?

Not on your life, I replied.

Even if its for Dr Patrick? You could learn a lot for all of us.

I walked over to the noticeboard. There was a typed request for a locum to cover his practice for a day, from 9 am to 9 pm. It would involve a morning and evening surgery and calls between times. The typing wasnt great there was plenty of evidence of erasures and smudges where errors had been corrected . These were the years before Tippex. The paper was cheap and so thin that there were spots where the force of the keys had made holes in it. It was signed by Mrs Patrick, in a hand nearly as shaky as the good doctors had been on the cigarette packet.

My only experience in GP had been during training, but I had to start sometime, and in those days, once you had finished your first hospital year after qualifying, you could legitimately do any GP job you pleased. Two years into the profession, I felt I should surely be able to tackle a day in practice. I decided I needed to know this guy, so I stepped across to the outside line telephone and dialled the number on the letter.

The following Saturday, I arrived by bus (I didnt yet have a car) at the surgery doorstep. It was ten to nine. The front door of the three-storey red brick terrace house was still locked. A forlorn line of beaten-looking people was standing on the pavement , waiting patiently. I bid the queue a cheery good morning and was greeted by a few half-hearted replies. I rang the bell. An elderly lady answered: she was thin, careworn, with grey hair tied neatly in a bun, and a deeply lined face. They werent laughter lines. She had a cigarette hanging from her lower lip. I wondered how she managed to keep it there: maybe it was stuck there by the smear of lipstick.

And you will be the locum? she said. The cigarette still hung there as she spoke. Please come in. She glanced at the patients waiting out in the cold, ushered me inside, then shut the door behind me, leaving them there to deepen their impending hypothermia. I mattered, it appeared, but they didnt.