No White Coat

by Rosemary Friedman

Genres: General Fiction

Synopsis

When the young registrar leaves his post in the hospital for a career in General Practice, he has a lot to learn. There is no white coat to buffer him from the immediate demands of his patients and no support from colleagues to aid diagnosis. He also has to cope with rejection from the beautiful Sylvia who has no desire to be a GP's wife. As he gets to grips with the demands of his new position, he grows in confidence and acquires a deeper knowledge and understanding of his profession, his patients and himself. This is the first of a series of five novels about the eventful life of a young GP.

Release date: June 30, 2013

Publisher: Quercus Publishing

Print pages: 313

Sample

It was spring; a delicate, lilting spring of a hundred forgotten smells and pink, pink almond blossom, when, after an anxious and sterile winter, I was finally chosen by the Executive Council to run a general medical practice. It was a vacancy created by the death of a practitioner, whose sole care it had been for fifty years, and it was in a pleasant suburb not too far removed from town.

Paradoxical as it may seem, I resented my predecessor’s hasty and inconsiderate demise, before I had had the chance to make his acquaintance or ask him about how to manage a practice in the National Health Scheme. I was left to find out for myself, and I had very mixed ideas of what to expect.

My impressions of the life of a family doctor had been gathered largely from the cinema, which, in its ‘U’ films, depicted his round as being an endless riot of humorous situations interspersed with games of golf; while the films awarded an ‘A’ certificate unfolded a sad and heart-rending melodrama in which, at the end of the reel, the respective gratitudes of nurses, colleagues and ‘snatched from the jaws of death’ patient, were moving to behold.

In actual fact my first year of practice showed me that the path which, as a GP, I had to tread lay midway between the tears and the laughter; if anything, slightly nearer to the tears.


Two years of post-graduate life as House-Physician and House-Surgeon in hospitals had done very little to prepare me for the new life which I was about to lead. I had become adept at doing a lumbar puncture and could put up a drip almost with my eyes closed. Before many months had passed, however, I would willingly have changed either of these accomplishments for a little practical experience in the recognition of a case of measles, the tiny, mocking manifestations of which I had never seen outside the improbably pink pictures in my reference books.

In hospital I had hazarded a diagnosis and, if stumped for one, had fallen back upon that of the GP who had sent the patient in, and had left its confirmation or repudiation to my superiors. Peerless in my white coat, I abandoned the patient with his grumbles and interminable queries to the never-failing sympathies of the nurses.

In general practice there was no buffer between myself and those for whose well-being I, in my comparative youth and relative ignorance, was responsible. With the relinquishing of my white coat I bumped down abruptly to mortal level and became inextricably tied to numerous bedsides by the twisted but efficient cords of countless telephones. I no longer worked spasmodically during my twenty-four-hour spell on duty and pointed a gloating finger at Faraday, my close friend and brother House-Physician, during my twenty-four hours off. In my first winter in general practice there were times when I worked while others slept, yet did not, of course, sleep while others worked. I would gladly then have changed places with Faraday and, during my working hours, lazily toasted crumpets in front of the fire in the Doctors’ Sitting Room.


My hospital experience had made me familiar with routine and duty, long hours in the theatre and notes at the ends of beds. Now I was forced, for the first time, to establish contact with the soul between the sheets. And to secure a contact was not enough. I had, by sheer force of personality – which, I was to learn, had nothing whatever to do with medicine – to throw out a life-line of confidence which, if it found its moorings, formed that fragile, none-too-resilient, doctor-patient relationship, without which it is impossible to practise successful medicine. I had voluntarily forsaken my hardworking, fat-legged, white-capped intermediaries, and with them the temperature charts, the neatly written, accurate reports and other previously prepared indications of the patient’s progress. I had now not only to use my eyes and ears but also my tongue. It was now necessary to acquire that undefinable and elusive attribute, which in hospital I had managed very nicely without – the bedside manner.


In general practice, as I was very soon to discover, curing the patient of his illness, real or imagined, was only part of my job. I might be expected, during the course of any one visit, to inquire after the recently acquired grandchild, suggest a remedy for the ants which crawled and crept insidiously through the cracks in the window-sill, make known my pet treatment for athlete’s foot (to be passed on by letter to Cousin Ethel in Wigan) and sample and pass a verdict on the Dundee cake. To be any sort of a success I had to learn, and learn quickly, to talk to people; to forget my hospital aloofness, a sort of superior silence, and to talk, naturally and easily. At first the going was rough, but after a month or two of dealing with toddlers, schoolchildren, Mums, Dads, Grandmas, Grandpas and old Aunt Aggies, the casual remark slipped easily off my tongue. I soon discovered the exact inflection of voice required to secure from young and old, without a vestige of resentment or embarrassment, an accurate reply to the doctor’s sixty-four-dollar question: “Have you had your bowels open today?” I learned to recall the ‘good old days’ with Grandpa, to sigh over the latest crooner with daughter Joan, to humour Mum when, in floods of tears, she declared the daily round ‘too much’ for her, and to console the old ladies with a blown kiss and the assurance that they were looking ‘better than ever, dear’. In fact, I seemed never to stop talking. I chatted of this and that while proceeding with any necessary examination or treatment, and soon forgot my reserve when my, at first calculated, camaraderie became genuine and I found myself an integral part of the life-web of my patients.


This, however, was all yet to come. When I stopped the car on that tender spring morning outside my new home it was impossible to believe that God would allow anyone to be ill or to suffer. The grass verge at the road’s edge was a delicate ‘new’ green, and in the neatly divided suburban gardens the daffodils proudly trumpeted the unfolding of the year. Beneath a sky that had neither the full blueness of summer nor the sad, mauve depths of autumn, but a kind of pale, promising lightness, I had to stop for a moment and inspect my new brass plate. I wondered what the years would bring before the brass wore thin and the green moss crept inevitably up the post to which it was attached. Suddenly I was conscious of my name exhibited so baldly for the first time on the street corner, of the twittering arguments of the birds in the trees above my head, and of the fact that the brass plate, put up over a week ago as a pre-view of my name and surgery times, had been polished to a dazzling brightness.


The house was large, solid and rather old-fashioned. It was the kind of house which young couples were buying, knocking down the walls between out-moded kitchen and tiny morning-room and creating the modern ‘kitchen-dinette’. The houses themselves were comparatively cheap for their size because the district, although the residents would die rather than admit it, had become with the passing of the war years and the now-forgotten exodus of the bombed-out families, for whom the dwellings had been requisitioned by the Government, déclassé. Today the street was empty, yet I felt that from behind the net curtains, some dingy in the sunlight, I did not go unobserved. The gate, unhinged at the top, squeaked as I opened it, and the crazy paving of the front path showed several bald, mossy patches. Accustomed only to maintaining one impermanent room in various hospitals, I suddenly realised that I had now, in addition to becoming a GP, become a householder and could expect to spend my Saturday afternoons mowing, clipping, oiling and banging in company with my neighbours. With a newly perceptive eye I noted that the gutter was sagging, the window-sills in need of creosote and the surgery windows partially obscured by the new twisting tendrils of some prolific creeper. A black cat jumped over the hedge which divided my property from the next and, without a curious glance at its new neighbour, crossed my path, I hoped, with good luck.

On the doorstep I put down my medical bag – it looked horribly new – and felt in my pockets for the front-door key. I found my pipe, an ampoule of distilled water, two golf tees and a lipstick of Sylvia’s (one of her more irritating habits – she hated to carry a handbag), but no key. I grew hot under the collar and visualised myself driving down again to Frinton; then I remembered having put it somewhere the night before so that I shouldn’t leave without it. I snapped open the front of my case, and there, in one of the little drawers, beneath my shaving kit and a bundle of Sylvia’s letters, was the key.


As soon as I opened the door I sensed, because there was nothing to see or hear, that someone was in the house. The hall was tidy, but empty, save for my predecessor’s ugly, comfortable, time-defying furniture. I shut the door gently and, standing on the mat, listened for some sound. Walking silently in my rubber-soled shoes I looked in the morning-room, the dining-room and the lounge. They were all empty and had that muffled feel from shut windows and lack of human attention. I was just about to continue my inspection on the first floor when a voice called, making me jump, “Is that you, Doctor?”

“This is me,” I called back. “Who are you? And where are you?”

“In the kitchen, making a cup of tea.”

The kitchen, large, square and inconvenient, was flooded with the fresh air that flowed in from the open windows. At the cooker, the tea-caddy in her hand and her hat on her head, stood a large, middle-aged woman in a flowered overall. She barely inclined her head towards me and put three scoops of tea in the pot. With the nonchalant ease of years of practice she swept out a long arm for the steaming kettle and with several mystic stops and starts filled the tea-pot.

“Thought you’d be wanting a cup,” she said, and waited with one hand on her hip and the other clutching the pot. “Had the kettle boiling. Won’t be a minute now, just drawing.”


“If it isn’t a rude question,” I said, unable to take my eyes off the brown, pudding-basin hat above the beaky nose, “who are you?”

“Mrs Little. How many lumps?”

“Three, please.”

“Not good for you” – she poured the tea in a translucent amber stream – “makes the blood too rich. That’s the way my poor father went – sugar.”

With this ambiguous remark she set the cups one each side of the kitchen table, and, scrabbling a capacious, shabby shopping-bag which stood on the draining-board, she brought out a packet of biscuits.


“Only digestives,” she remarked. “Get fresh on Monday.”

Because there seemed nothing else to do, and because the cup of hot tea looked excellent after my long drive, I sat down and started to stir. The steam rose in tiny spirals from my cup.

“Drink a lot of tea in hospitals,” Mrs Little said. “Used to work in the Isolation. Too hard on the feet!” She sipped her tea with the doubtful, testing expression of the connoisseur, then, seemingly satisfied with her brew, she sat back and nibbled a digestive biscuit.

“As I was saying,” she said, when in fact she had not been saying anything at all, “I used to oblige sometimes for the old doctor, God rest his poor soul, so when I saw in the paper you’d be wanting a housekeeper I said to my sister – Margery, that is; three lovely children – I said now that my poor husband was gone I might as well take the job, knowing the house and the phone and most of the people. Need a wife really in your job; women are funny about young, unmarried doctors. Not that it would worry me.” She sniffed her contempt for the rest of her sex, and nodded towards the dresser.


Following her glance, I saw piled up in neat heaps what must have been about two dozen letters.

“For me?” I asked.

“Answers to the ad,” she said; “fair game, ‘Doctor wants resident housekeeper.’ By the way they read, more than half had their eyes on the main chance. ‘I am young, attractive and very domesticated,’” she quoted in a mincing voice. “I wrote and told them what they could do with it.” She looked at my raised eyebrows and, getting up quickly, took her cup over to the tea-pot. “Knew you wouldn’t want anything to do with that sort,” she said – “not in this job.”

It appeared, for the time being at least, that I was stuck with the large Mrs Little. Watching her loping round the kitchen with her long, reliable-looking strides, I thought that perhaps it wouldn’t be such a bad thing. At least she could tell me a thing or two about the practice and, later on, if things didn’t turn out too well, I could always ask her to leave. Suddenly, I remembered my mother’s advice before I left. I cleared my throat, and after a second, blew my nose.

“Er… Mrs Little,” I said, watching her empty the tealeaves into the sink basket, “there is just one little point…”

“References?” she inquired, and practically buried her long nose in the pot in an effort to see if it was clean; “ask anyone. One thing you don’t have to worry about is me.”

I gave up, but doubted whether my mother would be entirely satisfied; perhaps, however, she had never tried to argue with a woman twice her age, six feet tall and wearing such a formidable hat.

“I’ll go and fetch my luggage from the car,” I said.

“Three pounds a week, half my stamp and plain cooking,” came a voice from the sink. “No dailies; can’t stick ’em. Rather do it myself.”


“That’ll do nicely.” I remembered my mother saying some-thing about no boyfriends in the kitchen and home by eleven on half-days, but taking another look at the brown felt hat, decided that I was justified in giving it a miss.

The harsh shrill of the telephone bell made me jump, and I looked round for the instrument.

Mrs Little flung the tea-towel over her shoulder and unhurriedly strode past me into the hall. The ringing stopped.

“No, I’m sorry, Doctor hasn’t arrived yet,” I heard her say in her soft, reassuring voice. “He’ll be in surgery in the morning, so if she doesn’t seem any better, ring again. Yes, an aspirin won’t do any harm. No, there’s nothing to worry about, and Doctor will be here in the morning. Good-bye.”

Back in the kitchen she picked up the half-dried cup she had left.

“You don’t want to see anyone today,” she said; “you want to get your things unpacked and sort the surgery out.”

“Yes, Mrs Little,” I said; “sort the surgery out.”

I left her to her womanly tasks in the kitchen and went to fetch my luggage.







I soon saw exactly why Mrs Little had been so keen on my sorting the surgery out.

The surgery and waiting-room were built on to the side of the house and had a separate entrance round the street corner. From inside the house, a door led to the waiting-room from the hall. The waiting-room wasn’t so bad. The benches and long centre table were oak, dark and miserable. The curtains had once been blue, but now, worn and faded, presented a peculiar striped mauve-and-grey effect. A few tattered magazines interrupted the dust on the table and one or two brown-looking prints hung from the picture-rail. In the fireplace a fern drooped. With the room itself there was nothing basically wrong, but since the Executive Council had insisted that I start getting the practice in motion again immediately, I had had no time to do anything about painting or brightening the place up. As my mother said, I would have to have it done up ‘round me’. For the moment it would have to stay as it was, improved only by a large dose of fresh air, soap and water. I flung open the windows (rather an over-statement, as they were as stiff as Old Harry) and looked round as I heard a shuffling behind me. There stood Mrs Little, her hat still on her head and armed with mop and bucket. I smiled at her, pleased that she had anticipated my wishes, and she, at one and the same time, nodded her head in acknowledgement and sniffed deprecatingly at the state of the room. I left her planning her method of attack and moved on into the surgery.


Outside a library, I had never seen so many books as there were in that small surgery. So many books and not a single book-case. They lay piled high on the examination couch; they lay, interspersed with dusty piles of old medical journals, beneath the examination couch; they lay in drunken rows on the window-sill, blotting out the light. They topped the filing cabinet, uniting it with the ceiling. They obscured the surface of the desk and filled in the knee-hole. How my predecessor ever examined a patient, I couldn’t imagine, but could only presume that he did it on the floor, a small section of which, leading to the dispensing cubicle, was uncluttered. I rolled up my sleeves and with a little heaviness of heart, as I thought of the spring sunshine outside, set to work.


Mrs Little scrubbed and I worked my way, fascinated, through the books. I piled them into cardboard boxes, for removal to the loft, in an attempt to create a little. . .