Malinger: A Short Story
Stella hated tears. Especially in the consulting room. At the tail end of a long winter, being exposed to sniffs and snivels and associated forms of mucoid expectoration was unavoidable; she kept her distance and carried on. Lacrimal fluid was another matter; the male variety in particular. Female tears could usually be stanched by a plentiful supply of tissues and maintaining deep eye contact for longer than she really had time for. Male tears were rarer, trickier, and she wasn’t sure what was worse: the soundless ooze of an old boy’s epiphora, or the strangulated sobs of a fortysomething, able-bodied male, like the one who stared past her with such intensity that she turned to see what had transfixed him. There was nothing to see but the overlapping slats of a beige venetian blind.
All the consulting rooms had blinds which remained closed for the purpose of patient confidentiality though it was doubtful that the low, red-brick block drew much attention from passers-by. Just around the corner, on the main street, were many more alluring sights: the animated knots of humanity glimpsed through the windows of coffee shops; a greengrocer’s display of plump, perfectly formed fruit; buckets of scented blooms at the florist’s door; gift shop windows dressed to simulate treasure troves.
Of more interest to Stella was the public park where, occasionally, she might snatch a brisk, head-flossing walk ahead of afternoon surgery. That day she’d had no such luck. Her lunch break was given over to arranging an ambulance for old Mr Gunn, who had tumbled into the waiting room like a bedraggled pigeon, clawing at his chest in a dumbshow of fear and pain. He was in the early stages of a coronary. Time was of the essence. His own GP, Jocky Craven, was taken up with another possible emergency, which turned out to be a false alarm, so she stepped in.
Why didn’t he call an ambulance? Craven asked, once the patient was on his way to A & E, in the capable hands of a pair of breezy paramedics.
Didn’t want to make a nuisance of himself.
Gimme strength, said Craven. If he’d collapsed on the way here he’d have made a damn sight more nuisance of himself.
Stella was running late. Very late. Doors were being closed, keys turned in locks. Footsteps padded down the carpeted corridor. Farewells floated through the sliding glass doors which separated the consulting suite from the waiting room.
You’re your own worst enemy, Craven said, sweeping out of the building at six on the dot, followed closely by Mo, the bossy, brassy receptionist who reminded her, as if by then she still didn’t know the drill, to check the burglar alarm when she locked up. As ever, Mo couldn’t stay a moment longer; she was not contracted beyond six, had responsibilities outwith the workplace and so on. She wasn’t the only one.
Stella pulled up the patient notes on screen and slid a box of tissues across the table.
Sorry for the wait. What seems to be the trouble, Mr Strang?
Rob, he sobbed. It’s Rob! I was – sob – here last week.
Just a sec. The computer is sluggish today.
The computer was always sluggish.
Ah yes, she said. So you were. Insomnia. Any improvement?
No.
She switched on the overhead light and the patient sprang into startling relief. His look had more than a touch of Jean-Luc Godard’s New Wave: charcoal suit, black jersey and Chelsea boots, which might have been retro-cool had the suit not looked slept-in, the jersey not been flecked with lint and the boots crying out for a polish. His chin was stubbled, his floppy hair awry and there was more than a whiff of smoke and booze about him. At least it was the end of the day; the cleaners would air the room before the start of morning surgery.
That’s better! she said brightly. Can’t be sitting in the dark though there’s a lot of it about at this time of year.
I – sob – prefer the dark.
Well, yes, I’m a bit of a night owl myself but we all need light: daylight in particular.
I don’t – sob – have SAD.
Seasonal affective disorder is more widespread than people imagine. And lightbox therapy can be surprisingly effective –
I don’t – sob – need – sob – a SAD lamp! What’s wrong with me is not – sob –seasonal-specific. It’s incessant.
He blew his nose noisily.
I can’t – sniff – do this – sniff – anymore!
Stella offered a brisk smile. Was sniffing progress? She must focus on making progress.
Another door closed. More footsteps padded down the corridor. She was due to meet the gang after work. Food followed by a film. It was likely she’d have to miss the food and she’d already missed lunch. Wine on an empty stomach was a bad idea. She could bolt down her lunchtime sandwich though it would be limp and soggy from having lurked, cling-filmed, in the staff fridge for ten hours. Or grab a slice of pizza from a takeaway, or something less likely to make a mess. If she didn’t want to abstain from wine – which, tonight, she didn’t – or find herself wracked with cramps after a couple of sips of white, she would have to eat something.
Once more, the sliding doors whooshed and clunked.
It was against regulations to work on without another staff member in the building but rather than endure Mo heavy-footing it down the corridor, tutting and sighing, Stella was prepared to take her chances: the surgery had a direct line to the police station and the neighbourhood watch was nothing if not zealous.
So, Mr Strang – Rob – what is it you think you can’t do anymore?
I don’t think I can’t, I know I can’t!
Okay, so could you give me an idea of what you know you can’t do? Splitting hairs took up time she really couldn’t spare but the patient seemed to require some pacification.
Any of it. I can’t do any of it any more.
Now that doesn’t sound good.
Stella suppressed a yawn. And a sigh. It was the time of day when her blood sugar as well as enthusiasm for her vocation dipped. Manifestations of existential angst were best dealt with earlier in the day. She scanned the symptoms the patient had previously presented to her: anxiety, low mood, insomnia, hyper-ventilation, heart palpitations, joint pain, loss of appetite, headaches, tinnitus, stomach cramps, exhaustion, lack of concentration. Stress. All too real, all too familiar. It was some small consolation that the patient had also consulted Craven recently about loss of libido and a rash in the groin area – but why didn’t he take his string of stress-related ailments to the GP he was registered with, rather than to her?
Over the last few months, she’d run blood and urine tests. When he fretted about having some kind of tumour, she’d arranged X-rays, ultrasound and MRI scans. When nothing untoward showed up, he became anxious that the scans were inadequate, or the scanners faulty. She’d prescribed various medications, all of which he insisted caused adverse reactions or induced new symptoms. She’d suggested drug-free treatment, online self-help courses in stress reduction, which he claimed to have tried, to no avail. She’d written him sick line after sick line. Was he at it? Was he a hypochondriac, a malingerer? It was common enough for pressure to be put on junior doctors to supply unwarranted sick lines but did he really think that one of the most senior doctors in the practice was a soft touch?
Stella hated being spun a line. Especially by youngish, good-looking patients, with good jobs and good prospects. Of course, she couldn’t be certain he was fabricating. It was human nature to embellish the truth but anybody could find a list of symptoms on the web and, in a ten-minute or even a twenty-minute appointment, how deeply could any doctor dig? Though he was more crumpled and dishevelled than she remembered, his didn’t look unwell. His skin had a healthy glow, his droopy, spaniel eyes were clear, if pink-rimmed from weeping and, despite his avowed desperation, there was nothing of the defeated slump in his posture. On the contrary, he was straight-backed, gripping splayed knees with slender, smooth-skinned hands that had seen little manual labour.
She ran through a series of standard lifestyle questions on exercise, relaxation, diet, alcohol consumption – where most patient lying took place. His bored tone and clipped responses made it clear that he considered himself above such mundanities.
Could you maybe try, Mr Strang – Rob – to specify aspects of work you are finding particularly difficult?
All of it. Everything. The people, the place, the conditions, the atmosphere, the smell of the place gets to me. Even when I’m not in the building – when I’m at home, out with friends, when I’m falling asleep, trying to fall asleep, when I am, eventually, asleep, as soon as I wake up, before I’m barely conscious – it gets to me. It’s all I think about, all I talk about. Not that anybody wants to hear.
There is no denying the adverse effects of work-related stress. How long have you been in your present employment?
Too long. Fifteen years. Fifteen years of being overworked and underappreciated.
Stella flung him the most fleeting of smiles. She had close on thirty years of being overworked. And if you include all the weekends on call, as Craven liked to remind her, that’s another four years not accounted for. Four years! As for being underappreciated, you didn’t really go into medicine to be appreciated, did you?
You’re a teacher – is that correct?
Lecturer. In Film Studies.
Nice.
It’s not. At all. You have no idea.
Perhaps it wasn’t the best choice of word but how hard could it be to watch loads of films, form some opinions about them and be paid for the privilege? She loved everything about the cinema: the ubiquitous, ingrained smell of popcorn; the sweet and salty dark of the hushed auditorium; the swirl and ripple of the gilded curtains as they slid silently apart; the sense of being released from the relentless plod of time and the need to corral it into appointment-sized blocks.
Downloading from Netflix was cheaper and more convenient than a trip to the cinema but had none of the magic of the big screen. And being able to pause and resume play at will somehow accentuated flaws in a storyline, cracks in character construction, laid bare contrivances and technical tricks. It was harder to be drawn in, suspend disbelief, to ignore everyday demands, especially since Mick had become so much more dependent on her. It wasn’t his fault his concentration was shot after an hour or so, or could no longer follow a complex plot; or needed, frequently, to be helped to the loo.
But don’t you still love films?
Rob Strang sighed.
I no longer watch for pleasure. I watch because it’s part of my job to watch. Do you have to like people to tend to the sick? Besides, I don’t teach film appreciation. Film studies takes a more theoretical – and increasingly philosophical approach. The focus is not whether a film is enjoyable but what it tells us about the societal structures within which it operates. If you ask the wrong questions – as I expect you know, Doctor – you are likely to get the wrong answers. Everybody knows that film is illusion, deception. Every angle, every shot, every word, every note of music exists to manipulate the viewer. When we imagine we see people walking and talking, we are not only watching an actor playing a part, we are fooled by the medium itself into
believing that we see motion. Film studies asks whether film presents an imitation of reality or its own, different reality.
The sobs had dried up, the crack in his voice vanished and the tone had perked up considerably, as if Rob Strang had begun to address a roomful of rapt students.
Have you thought about a career change?
Don’t make me laugh. I’m so very fortunate to be in gainful employment in such an illustrious institution. I really should go down on all fours to show my appreciation but that fact is I can’t eat, I can’t sleep, I can’t concentrate. I can’t do what I’m paid for. Not properly. Not the most important parts.
Which are?
Well, teaching, it goes without saying, which has to be squeezed into whatever space is left after the information logging has eaten up the lion’s share of my time and energy. But first and foremost is research. And forget the personal career development side, effective teaching is based on research.
Don’t people in your position have sabbatical leave for that?
Some. Every so often. A sabbatical is supposed to be supplementary to ongoing research. Not the only time you can get around to doing any.
Ah. And what do you think might make things easier?
Not having to put up with all the bullshit, day in, day out. Not being badgered into producing endless reports. These people – middle managers, admin officers, website developers, data processing geeks, whatever – don’t, can’t, or won’t appreciate the abstract and essentially unquantifiable nature of the beast. How do you measure the genesis and development of an idea? How would you express the process on a spread sheet?
I have no idea, said Stella, making no disguise of glancing at the wall clock.
You don’t, said Rob Strang. You can’t. And yet these corporate cogs not only expect me to log my every move, they demand it, as if I’m some layabout who spends his days rearranging his bookshelves. Or a dolt who can’t follow instructions. I’m not a layabout, nor a dolt. Nor am I a technophobe. Nor do I have time to spend a morning, afternoon or, God forbid, a full day becoming acquainted with another method of recording information. How many means and meridians, percentile points and averages does any teacher, or student, need? How many graphs and pie-charts?
Few people enjoy admin, said Stella, but there’s no getting away from it. In the medical profession we –
I work hard! I want to be good at my job, I need to be good at my job but demands for some needless report or other drop into my inbox on a more or less daily basis – I’m not prone to exaggeration, doctor – and make it impossible to think. I am expected to think. I am paid to think yet everything seems to conspire to prevent me from thinking. By the time I get through a day of bureaucratic bullshit, I’m fit for nothing. But if I don’t do the research, if I don’t publish my findings, I lose credibility in my field. And if I lose credibility, the programme won’t make enough
profit – academia is a business and a cutthroat one at that – and sooner or later I will be out of a job. All because the powers that be prevent me from doing my job properly, the job I signed up for. Do you see the problem, doctor? The horse must come before the cart. The horse must come before the cart!
Once more Stella proffered the box of tissues but he waved them away.
No thanks. My crying jag is over.
So, what do you think would help? she asked. As if she didn’t know.
She placed the box of tissues beside the desk tidy with its sheaf of ballpoint pens, freebies emblazoned with the logos of drug companies. These days she was rarely called upon to hand-write anything more than her signature on a prescription or a sick line. Jocky Craven, whose writing implement of choice was his Montblanc Meisterstück, had been keeping a diary since his days as a houseman. He allotted a portion of each lunchbreak to blackening pages of one of his many Moleskines. Was he penning reflections on the meaning of life, confessing intimate personal details, sniping at colleagues? Craven kept them all guessing: nobody managed so much as a peep at his diary. Stella didn’t want to write a diary. She wanted the time in which she could write a diary if she felt the urge.
It had been Stella’s turn to choose the film. Her taste tended towards gritty, hardhitting realism and tonight’s feature was likely to be no exception. Set in present-day Norway and Afghanistan, the story revolved around the plight of an adolescent refugee caught up in organised crime. She anticipated some grumbles about the lack of premium placed on entertainment value. And the effort involved in having to read the subtitles. But wasn’t the point of a film group to broaden horizons?
Over the years they’d had pleasant and unpleasant surprises, challenges to which only some had risen. Feathers had been ruffled. Boredom, bewilderment, disgust, horror, hilarity had been voiced. There had been serious and not so serious differences of opinion. Fallings out and fallings off. Numbers had dwindled to half-a-dozen stalwarts, all of whom had become a tad predictable in their choices.
Not that the film mattered all that much. Post-mortem on what they’d seen tended to be brief, with conversation segueing into a good old moanfest about work, the state of the world, men. Over the past year, Stella had become less vocal on the man-bashing front. Mick’s condition had deteriorated yet his graciousness in the face of suffering remained constant; venting any gripes felt mean, disloyal. Besides, people assumed somebody in her line of work to have expert coping strategies, which wasn’t the case, nor did it help to know in detail what to expect from Mick’s continuing decline. But a
monthly night out with the film group could remind her that there was more to life than illness.
Well? said Rob. Are you going to sign me off?
Taking a long spell off work, Mr – Rob, can create its own problems. It might be better to sign you off on a weekly basis and keep the situation under review.
That won’t work. It will only add more stress. Can’t you see that?
The longer you’re off, the harder it can be to go back.
I’ll take a chance on that.
Stella was light-headed from hunger, from missing lunch on account of Mr Gunn and his incipient coronary, Mr Gunn who wouldn’t have wished anybody in the practice to address him as Alan, although Mo got away with calling him an old rogue when he’d forgotten to bring along a urine sample. Alan Gunn was another of Craven’s patients who had taken to making appointments with her, though only for complaints above the waist or below the knee. Anything pertaining to his nether parts he took to Craven. It wasn’t a sick line he was after; he’d been retired for years. So what was it
– a gentler touch, a bit more sympathy than his own GP had to spare?
Think yourself lucky, my dear, said Craven, as the paramedics had wheeled the patient, soft and grey as putty, down the path to the waiting ambulance. You have the man’s heart and mind. I’m stuck with his prostate, his piles and his penis.
She had intended to call the hospital mid-afternoon and check on Mr Gunn but no suitable window of time had materialised. Mo, in imperious mode, had plagued her with no end of piddling queries about repeat prescriptions and lab results, and the computer had been refusing, resolutely, to play ball. Her last appointment of the day had begun very late and then spilled well over standard appointment time. The gang would already be ensconced in their favourite bistro, blethering at full tilt, as if they hadn’t seen each other in years. One of the young, cute waiters would have poured each of them a glass of Prosecco and they would have gone ahead and ordered food because they knew how rubbish she was at time-keeping.
She checked that she had completed all the relevant boxes, double-checked the dates, printed out the form, added her signature with a stubby pink pen advertising a gel for dry eye. She slipped the sick line into an envelope, passed it to Rob Strang then stood up.
If there is any change, improvement or deterioration, you should contact Dr Craven in the first instance.
If you say so.
Stella escorted Rob Strang down the corridor and through the first sliding door. She waited as he made his way, rather more slowly than she would have liked, across the deserted waiting room and through the second sliding door which led to the street door, then returned to her consulting room. It had been dark when she arrived; it would be dark when she left. She shut down the computer then dialled the hospital, psyching herself up for the several minutes of Vivaldi it was likely to take before she’d be put through to somebody who might be able to provide information on Mr Gunn’s condition; she hoped it would be stable.
SCOTTISH REVIEW OF BOOKS
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