by Katherine Shand
Breakfast was muesli and 650 emails, most of them unread. Atul Gupta scrolled through his inbox, looking for new, urgent messages - messages which were more urgent than the urgent messages from yesterday. He checked his diary and made a mental checklist for the day. Complaints Meeting at 4.00 pm. Reminder: Have you read the End of Life Audit Report? No.
A vice-like grip encircled his back and abdomen and he soothed waves of nausea with a mug of sweet tea. Yesterday had been difficult. Trainee upset, again. Frustrated colleague. Abused child case conference. District nurses meeting. Another organisational decree from Above. A near- miss with meningitis. Today would deliver a similar cocktail so he told himself, firmly, to avoid reflecting on anything other than the immediate tasks. Anxious thoughts would only rob him of the little concentration he had left. Thinking about Preeti, in particular, was forbidden.
The traffic flow in town was in Atul’s favour and he saved precious minutes. He decided to, finally, write that letter to the local MP, before surgery. He crept into the Health Centre, trying not to draw attention to himself. He wanted to get the letter finished and hadn’t the stomach for Good Morning, Doctor Gupta, how’s your wife? However, a receptionist was on lookout duty and pounced. One of the ladies’ toilets was blocked and Carol, the Practice Manager was on holiday. Don’t you remember, Doctor? Can someone else please call the plumber?
Atul switched on his computer and messages from Reception, pinged across screen. He ignored them and reached for his dictation machine. He needed to focus. If the MP was to help bring Misha’s asylum review forward, on health grounds, Atul needed to strike a delicate balance
between professionalism and begging, However, he had already accepted the likelihood of failure and by tomorrow he would have forgotten all about the writing the letter, anyway.
Atul consulted with 34 patients and failed to keep within the allocated ten-minutes for all of them. Avoiding eye contact and rigidly sticking to the one-problem-only rule helped, but he still ran late every day. He couldn’t remember the last time a patient presented with a medical problem he could diagnose, treat and cure. In his patch, everyone had social problems which he couldn’t solve. Every working day was an exercise in damage limitation and his role was to safeguard his patients against any impending catastrophe and above all, avoid making mistakes. His nemesis was to miss something life-threatening.
Atul wanted to get over to Elmhurst as soon as possible so his notes for the last patient were brief. As he was about to log off, the Lead Receptionist (whom he called The Smiling Saboteur) popped her head round his door with That Look on her face.
Just one more. You’re so good with him…..
It had to be Fag-End, didn’t it? He was one of Atul’s ‘heartsinks’. Heart disease, history of alcohol and drugs mis-use, hypochondria, minor crimes, divorced, malnutrition, lonely, jobless….more besides.
Fag-End wasn’t his real name, but his preferred nickname. He had an obsession with picking up fag ends from pavements, to keep the streets tidy, so he said.
Some locals thought Fag-End was intimidating but for Atul, he was just another sad, forgotten soul. Occasionally, Atul actually admired him, for his resilience and persistence, and wondered which of them would go first.
Loneliness was Fag-End’s main problem and it took Atul years to connect his patient’s hyper- anxiety with Bank Holidays, Christmas, Easter and his birthday. Fag-End had a mangey dog, called Dog, but Dog had died a few months ago and Fag-End was turning up at the Health Centre, every week. Since the squelching sofa incident, Atul had avoided visiting Fag-End at home, but recently, a postman reported that Fag-End’s letterbox was overflowing with mail and Atul felt obliged to check if everything was okay. Fag-End was fine and later he told his neighbour, that Atul was his brother.
Pathetic though Fag-End was, Atul found him extremely irritating because he never listened to anyone and was a pathological time-waster. Today, Atul was in no mood for discussions about the intricacies of the benefits system.
Fag-End perched on the edge of the chair and Atul tried not to recoil from the smell.
“How are you?” asked Atul. Fag-End coughed, dramatically.
“Not good, Doc…backache.”
For ten minutes, Atul listened impatiently, to a monologue of discontent, none of which was connected with backache. He nodded and offered a ‘yes’ or ‘no’ when appropriate. When he had
off-loaded sufficiently, Fag-End re-settled himself in the chair and this was Atul’s cue to initiate Act 2.
Atul performed a cursory examination of Fag-End’s chest. Strong, regular heartbeats. He measured Fag-End’s blood pressure. Satisfactory. He finished his ‘Laying on of Hands’ ritual by palpating Fag-End’s lower lumbar region, noting how easily Fag-End hopped on and off the couch. Perfect vertebrae and relaxed muscles.
“I see exactly what you mean,” Atul said.
Fag-End got dressed and Atul washed his hands, twice. He wrote a summary of the consultation, stabbing the keyboard so hard that it made Fag-End screw up his face.
Atul printed out a prescription for Vitamin D, the idea being that it was unlikely Fag-End was exposed to much daylight in winter, so Vitamin D might do him good - and certainly no harm. Fag-End was elated and left the consulting room, clutching his prescription as if it was a certificate of achievement.
Later, as Atul was driving to Elmhurst, he reflected on his consultation with Fag-End and his muscles tightened. Atul and guilt were old friends. Placating Fag-End with an almost- meaningless prescription was nothing more than witch-doctoring. It was like he had spent 25 years practising medicine only to find he was still practising.
Atul thought Preeti recognised him as he approached her bed, but when he stared into her dull eyes, he realised this was wishful thinking. He stroked her few remaining wisps of dark hair,
kissed her lightly on the cheek and using the corner of a clean tissue, he dabbed a dribble of saliva from the corner of her mouth. Then, he picked up the folder of medical notes.
Katya, a nurse, called to him from across the ward.
“Doctor Gupta, you should know better!”
Katya hurried across to him, her soft-soled shoes squeaking on the floor. She took the folder from his hands and put it back on the table.
“Preeti isn’t your patient! Be a good husband! Sit down and I’ll bring you some tea.”
“Am I allowed to ask how she is?” Atul asked.
“As comfortable as can be expected,” she replied and her face reddened with embarrassment. She knew, that he knew, how sick Preeti was, so she made her excuses and left.
Atul sat on the chair beside Preeti’s bed and talked to her, softly. He told her the weather was windy and he planned to cook some aubergines for supper. The latter was a lie but she loved aubergines. He also said he had done the vacuuming which was also a lie. But, then again, having a spotless house was important to her.
His eyes felt heavy and his words slurred. He said that the washing machine was watered, the flowers were filled and that Priya, their daughter, had a new girlfriend in Australia. Actually, it
was Luton and the girlfriend was really a boyfriend. Not that this made any difference to Preeti, she laid perfectly calm, her face empty of any expression.
Katya brought Preeti an afternoon cocktail of nutrients and Atul coaxed her thin lips to accept teaspoonfuls of the pink slime, joking that it was a pina collada.
“She’s lucky to have you,” a voice said, weakly.
Atul was startled. He hadn’t noticed the patient in the opposite bed. She was another shrivelled woman, in waiting.
“I wish I could see my Henry,” the woman said. “I don’t think they’d let him in, though.”
“Why’s that?” Atul asked.
“He’s probably got fleas.”
Atul swallowed hard. “Henry is your — husband?” he asked, tentatively.
“No, he’s my terrier,” she said. “The animal shelter’s looking after him for a while, but they said he’ll have to be put down, when I’ve gone.”
Preeti had drifted into sleep so Atul moved his chair closer to the other woman. She talked, he listened. She told him about her illness and treatment, that she didn’t get on with her daughter. No grandchildren. Her husband left years ago. Then, with huge effort, she shifted slightly in the
bed and buried her face in the pillow. Atul pulled the curtain around her bed and went quietly back to Preeti, listening to the muffled sobs of a dying woman.
Atul took Preeti’s pulse, sat down and watched her chest rising and falling. He felt soothed by the rythmn of each breath. How many breaths had Preeti taken without him noticing? He could do no more for her and should count every last heartbeat.
“Doctor Gupta, you’re nodding off,” Katya said, placing a hand upon his shoulder.
“Go and rest. Get some food. I’ll call you later.”
Atul rubbed his eyes and said he would go and finish some paperwork before his next meeting.
“Can’t you take some time off?” Katya asked, kindly.
‘Keeping busy takes my mind of things,” he replied.
In any case, he thought, taking a break would mean coming back to an ever larger pile of work and his regulars wouldn’t see another doctor. They would wait to see him. So, Atul checked the saline drip and Katya wagged her finger in mock irritation. He kissed Preeti tenderly on the cheek and stroked her frail, thin hands. Without saying goodbye, he left the ward.
It was not like Atul to take a wrong turn in the town he knew so well. Wilson Street was in the opposite direction to the Health Centre so he looked for a suitable place to turn round. As he was putting the car into reverse, he glanced across the road and noticed a familiar bungalow. It had
rotting window frames and a wild, unkempt garden. Just as the word ‘Henry’ popped into Atul’s head, Fag-End came out of the front door and for the first time in a long time, Atul’s heart didn’t sink at the sight of him.
Atul leapt out of his car and ran across the road. He grabbed and shook Fag-End’s filthy hands.
“I’ve got a really good idea…about a D-O-G, Atul cried. “Have you got time for a cuppa?”