Night Visit (3 page)

*

The rest of my surgery went smoothly enough, routine monitoring of various chronic conditions, one or two casual callers with backache and the usual children with temperatures.

When
Fern Blacklay, the receptionist, brought me in my morning coffee I used the time to dictate some referral letters before, refreshed, I picked up the next set of notes and inwardly groaned as I noticed the fluorescent sticker.

We
used the code to warn ourselves. Drug addicts may be a legitimate part of the GP’s workload but we have all learned to treat them with caution. Many were youngsters desperate for kicks to stave off frustrated teenage energy but some were hopelessly addicted without the volition to ever kick the habit.

Like
Reuben they would eventually die of their condition.

That
was their problem. Not ours. What troubled us were the means they used to finance their expensive habits, stealing anything they could lay their hands on in the surgery, not just needles and syringes and drugs but handbags, once an expensive coat. Even a nebuliser had vanished the day after one addicted ‘jackdaw’ had called in for a sick note to avoid doing his community service. So we doctors had to double up as police while they were around and had dreamed up a set of rules, that the receptionists should watch them the entire time they were in the waiting area and that the doctor should never leave them alone in the consulting room.

Danny
was slow to respond to my calling his name.

A
couple of minutes ticked by and I was contemplating calling him again although I knew he might have simply walked out. Some of the addicts quickly grew fidgety and impatient hanging around for their turn. They would pace around the waiting room, abuse the receptionists and frequently storm out—to everyone’s relief. There was something unpredictable about them that made other people afraid to make contact. Mothers snatched their babies out of their prams and hugged them close. The elderly would slide away along the bench seats while the receptionists eyed them warily from behind the glass screen. The unease would spread so everyone entering the waiting room took the long way round to avoid walking past them. I had witnessed it myself. It was as though they were surrounded by an aura of restlessness.

I
was about to give Danny one more call when the door was shoved open and he sauntered in.

‘
Good morning, Danny.’

I
would
be
asked
later
,
‘Did
you
dislike
the
deceased
?
’
And
I
would
answer
as
honestly
as
I
could
.
‘No
.
I
did
not
dislike
the
deceased
.
’

Pale,
spotty, scruffily dressed in an ancient and smelly long coat, Danny dropped into the chair.

‘
So what’s the problem?’

‘
I need some more methadone.’

Methadone
is the magic substance supposed to help addicts kick their habit. Only it does nothing of the sort. The truth is that most of them supplement their prescribed methadone with illegally obtained heroin or anything else they can lay their shaking hands on. There is only one way to avoid being the cheapest drugs dealer in town and that is to flatly refuse to prescribe the addicts anything. It is better to do a blanket referral to a substance abuse unit and let them sort out these human messes.

Danny
knew he was breaking the rules.

‘
Sorry, Danny,’ I said. ‘You know the score. You’ll get nothing from me. When are you next due at Substance Abuse?’

‘
Friday,’ he said pleasantly. ‘And I’ll never last till then.’

I
wasn’t playing ball. ‘But they give you enough for a week.’

He
stopped looking at the floor.

I
have learned that addicts never look straight at you except when they are lying. They break all normal rules of communication. We have to relearn all our instincts. Addicts never look more innocent than when they are attempting to deceive you and squeeze a couple of extra fixes out of the benevolent National Health Service.

‘
I met a friend,’ he said. ‘He was going bananas.’ Another pleasant smile. ‘I felt sorry for him. Gave him a couple of days’ of my own supply.’

Addicts
are inventive too. But it’s safest to play along.

‘
That was very nice of you, Danny, but it means you’ve let yourself go short.’

‘
Bloody typical,’ he grumbled. ‘You do a friend a favour and where does it get you?’

‘
Bloody typical,’ I echoed. ‘Unfair, isn’t it?’

He
eyed me suspiciously. ‘I’ll get withdrawal.’

‘
If I were you, Danny,’ I said, ‘I would take myself down to Dr McKinley and see what you can wheedle out of him. OK?’

‘
You’re my doctor,’ he snarled. ‘I got a problem. I need somethin’ for it.’

My
eyes wandered towards the panic button. ‘You’re right on one point, Danny,’ I said. ‘I am your doctor.’

He
thumped his grubby, bony fist on my desk, making the stack of notes hop.

‘
I want my methadone. OK?’

‘
No it isn’t OK,’ I said. ‘You know the score. We’ve told you before. I am your doctor. And as your doctor I have a clear, contractual agreement.’ I had stopped caring whether he knew what the word contractual meant.

Did
you
dislike
Danny
Small
,
Doctor
?
’

‘
No
...
No
...
No
.
’

‘
My duty is towards your health, not helping you with a habit which is slowly destroying it.’

He
looked at me with cold, dead eyes. Then came the threat. He stood up, leaned right over me. ‘Just pray you don’t meet me one dark night, Doctor.’

*

I struggled to regain my composure after Danny had gone, but the encounter had left me drained and depressed. I was glad that I had reached my last patient for the morning.

Doctors
read a set of notes as a fortune teller reads tea leaves. And this set was wafer thin, ergo they belonged to someone who visited the doctor infrequently. One did not have to be Sherlock Holmes to deduce this. But I could read more. This man was neither neurotic nor unhealthy. And I could read still more. The name was unfamiliar and so was the address, one I had never visited. So the entire family hardly needed the services of a doctor. I did not even recognise the road. So either his neighbours too did not summon the doctor, or they belonged to one of the other lists in Larkdale or he had no neighbours. I felt pleased with my deductions and memories of Danny began to fade.

I
shook the loose leaves out of the folder and read both name and date of birth. Anthony Pritchard, aged fifty-four. Last consultation ten years ago for a dog bite. There was no record of stitching or hospital admission but someone had recorded a tetanus jab.

So
what had brought him here today?

I
pressed the buzzer.

Patients
have various ways of approaching the doctor. Some march in boldly, almost aggressively, barging in without knocking and dropping into the chair as they blurt out the reason for the consultation. Others are timid, rapping softly on the door and hesitating before they dare enter.

We
have the power to frighten people. Minor conditions are magnified. Piles become cancers. Pleurisy a heart attack. Anxiety becomes any malignant condition in the medical textbook.

It
didn’t take me long to classify Anthony Pritchard. He was one of the timid ones, unsure and tentative. His first knock was so soft I wasn’t sure I had heard anything. For good measure I did call out, ‘Come in’ and the door handle moved slightly. I called out again, my eye on the handle.

There
was a second tap and the door opened wider. A man was hovering on the threshold, a plump man with a suet pudding face and thick, bottle-bottom glasses.

‘
Mr Pritchard?’

‘
Yes. That’s right. I am he.’

A
monotonic local accent, a wordy, pedantic way of speaking and an irritating, nasal voice. Not a good start.

‘
Come in,’ I said. ‘Sit down.’ One gets used to directing the proceedings.

He
closed the door behind him and perched on the edge of the seat.

His
trousers were too tight, plump thighs straining against the stitching. Navy blue with a grey stripe. Remnants of earlier days before his legs had encased themselves in wads of fat. Either that or from a charity shop. There were plenty of those in Larkdale. His shirt also looked either vintage seventies or charity shop, yellowed Bri-nylon, frayed at the cuffs. Over that he wore a brown, tweed jacket.

I
gave him an encouraging smile. ‘And what can I do for you, Mr Pritchard?’

As
I moved through the preliminaries I was scrutinising him. There were no obvious signs of disease. He was pale but not breathless, sweating slightly but the surgery was overheated. Maybe he was a candidate for an early coronary. I wouldn’t have swapped his cholesterol level for mine. There was a lardy look about his face. And I couldn’t imagine him taking much exercise. He was the sort of heavy hipped, amorphous man who had not been born to be an athlete. He had been put on this earth to pick away at details in front of a small, unobtrusive desk, sitting at the back of a dark, poky office.

I
also noted that he was nervous and needed prompting so I asked him again. ‘What seems to be the trouble?’

He
wriggled his glasses up his nose and gave an ingratiating smile. Even that didn’t do him any favours. He had bad teeth.

‘
I... wondered if you’d mind taking my blood pressure.’

Ten
years, I thought, since you last consulted a medic and you’ve come in today to have your blood pressure checked? I was honour bound to ask him a few more searching questions.

‘
Have you been having problems? Headaches, tiredness, spots before the eyes?’ Again that smile. He shook his head.

‘
No aches or pains?’

Another
shake of his head. Another smile. Another glimpse of brown, irregular teeth.

So
with nothing to go on I asked him to remove his jacket and roll up his sleeve.

His
top lip was beaded with sweat as he asked me which one.

‘
Let’s try the one nearest the sphyg, shall we?’ It was recognisable medical jollity, of the type they do teach at medical school.

Rolling
up his sleeves made the doughy fingers tremble so much I would have offered to do it for him had it not been for a nauseating smell of body odour. And now I knew another fact about Mr Pritchard. He was not fussy about personal hygiene. It took him ages to tuck the sleeve up his arm, one slow pleat after another while I tried to stem my impatience. I was unaccountably anxious to end the consultation. Eventually the manoeuvre was complete, the sleeve displaced well above the elbow and he rested the limb across my desk so I could wrap the cuff around it and pump up the bulb. Slowly I let the cuff down, my eyes fixed on the column of mercury until it reached the bottom. Then I unhooked the stethoscope from my ears.

I
might have known the level would be raised. The signs had all been here. Fat, lazy, greedy. The trouble was it was not up enough for me to commence treatment. A few lifestyle changes should be enough. But he was only fifty-four years old and age would exacerbate it. I needed to probe into his family history.

‘
Are your mother and father alive and well, brothers and sisters?’

‘
I have no brothers or sisters.’ He coughed. ‘I am an only child. My mother is alive,’ he said carefully, ‘though quite elderly and a little infirm.’

‘
And your father?’

‘
My father, unfortunately, is dead.’

‘
What of?’

I
wasn’t asking out of idle curiosity. If Pritchard’s father had died young from a heart attack, combine that with his son’s elevated blood pressure and it would mean we should keep an eye on things, maybe start medication earlier. My fingers were poised over the computer to feed in father’s cause of death. There was a long silence. I looked up.