When I’m not Writing

It’s a fun life, this novelist business: publishing and promoting a book, and getting a sequel going, while ideas for the prequel are also bubbling away.

What did I do before novelling?medical bag

A lot more doctoring, for a start.  Every day, the rich pageant of life played out in the consulting-room.  Many patients shared their innermost secrets, told me their darkest fears.  Most had washed, some hadn’t.  Their socks stood up unaided. 

A lot of them talked while I listened to their chests, so I had no chance of picking up the subtle signs learnt at medical school.  Or hearing what they were saying.

Frequently a patient would promise “This won’t take a minute, doc.”  Which was true.   It usually took at least half an hour.   The ones who took longest had often brought me newspaper cuttings about the latest ‘breakthrough’.   Sometimes it was an article I’d written myself. 

These days it’s all about patient-centred medicine.  I realised how far along this road we’d gone when a patient just to ask how feather pillows should be washed.  Some patients, of course, were really ill, like the young man with meningitis who turned up thinking he’d just badly strained his back.   Despite being sent to hospital by ambulance right away, he still ended up disabled. 

doorway to patient's flatWhen I was training to be a GP, I visited a lot of housebound patients.  Finding their homes could be a challenge.  Houses with names were the bane of my life, as were those where the numbers were too small to see from the road.  It was a straight choice:  stop every so often to peer at them, or drive with two wheels on the pavement. 

There were homes so dirty you wiped your feet on the way out. 

And high-rise blocks of flat which smelled of urine and carbolic (but mostly urine).  The lifts never worked, and if they did nobody would have willingly entered them anyway. 

There were tiny bungalows where a lot of patients kept the front door key hanging on a length of string inside the door.   You fished the string out through the letter box and let yourself in. 

Often there were dogs where you least expected them.  There were two kinds: the protective type bared their teeth as soon as you touched their master, and the other kind  stayed curled up on the sofa, unnoticed till someone sat on them.  Then they yelped into life and bit you on the bum. dog

Sometimes the patient was dangerous, like the young psychotic who locked me into the dining room and threatened me with shards of broken mirror.   

It wasn’t a wealthy area.  I’d get called out to see patients with minor injuries, if they weren’t sure it was worth getting a cab to A&E.  Funny they could always afford cigarettes.

The ones that I remember most vividly were the old people, living out their lives in one-bedroomed homes, surviving on their pensions (if they turned the heating down), their memories, and not much else.  They usually had a knitted blanket on their knees, a couple of faded photos on the mantlepiece, some tacky souvenir from a seaside holiday, and maybe a china dray-horse on the window-sill.  While there I’d check the kitchen cupboards.  They were often bare apart from a huge collection of medicines. 

All of human life could be found in patient’s homes, providing insights that are rarely glimpsed 25 years on.  I still see patients, but these days it’s almost always in the consulting-room.  Even full-time GPs don’t have the nearly same volume of home visits these days.  There’s no time in today’s high-pressure, high-tech primary care.  

Germs and Geriatrics

She is asleep with her mouth open, so Geoff sits down quietly and watches for a bit. At 92 she still has some of her own teeth but the interior of her mouth has that glazed look that comes with age, and with candida.

Geoff is a GP from the pages of One Night at the Jacaranda. He can’t help making these observations.

Grandma stirs, and soon she’s sitting up yelling for the nurse.  “I’m in agony” she’s saying as she jabs the bell repeatedly.  “I’m in agony” she repeats to the rest of the ward.   The three other old ladies appear to have heard this before. 

Today Geoff had to put on a mask and gown before entering the ward.  Some nasty germs have been isolated on the unit, but high bed occupancy means it can’t be emptied and deep cleaned.  He’d asked a nurse which germs, and got a shrug by way of reply.

agar plates

The lunch tray arrives.  It looks vile, all that sloppy food designed to slip down elderly gullets.  “Feed me” demands Granny.

She watches Geoff with beady eyes as he spoons some of the beige slurry into her mouth.  That’s probably where the germs are, he thinks.   After a couple of mouthfuls Granny has had enough.  She’s staring at his head now.  “I like your hair” she says and reaches out to touch it.

She reminds him of Davey.  She might like to see her great-grandson again, but hospitals aren’t good places for 5-year olds, unless maybe they’ve got Henoch-Schonlein purpura.

There’s a miniature Christmas tree on the bedside locker. “It’s nearly February” Geoff points out.  “And you’re Jewish.” 

“I’m 95 now” Granny replies with impeccable logic. 

A nurse comes in, switches off the call button and offers Granny tablets for pain. Which Granny refuses, saying she’s fine.  

The nurse then rearranges things at one of the beds.  Geoff notices that she hasn’t bothered with a mask, gown or gloves.  She senses his stare and says “I’m not touching the patients.”  The nurse probably wouldn’t believe it if Geoff told her that viruses and bacteria can live on call buttons, beds and bedding. 

“The priest came to see me” Granny tells Geoff.

“Why, Grandma?”

“Because I’m getting married, of course. To Marvin.”

This is news to Geoff.  “Do I know Marvin?”

Granny swats at him with a bony hand.  “Of course you know him.  He sits next to me in class.”

She’s gone downhill faster than he thought.   Only last week Geoff was thinking of testing her with the SAGE questionnaire for cognitive problems.  He hasn’t used it on patients yet but it looks a useful test, with low false positives, and no copyright issues, unlike the MMSE.  But not much point trying it on Granny any more.   Although her mental state fluctuates from day to day, she seems proper demented now.  An MRI of her brain would probably look like cheese.

Swiss cheeseNow she says “Make me comfortable.” 

The nurse has gone, so Geoff tries adjusting the hospital bed.  It has lots of buttons.  Granny develops a liking for the buttons that controls the foot end.   

No harm in that, thinks Geoff.  After she raises and lowers the foot of the bed about a dozen times, he remarks that it’s just like a see-saw.

She gives him one of her stares.  “You’re really very stupid.”

Before Geoff leaves, he asks if Marvin’s going to visit.

“Who’s Marvin?” replies Granny.

elderly hands

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How are you today, Granny?

Alzheimer’s online test crashes university site

Where on earth can you meet someone?

When you’re 30-something, it’s tough to meet people.  I know a couple who met on an allotment, but, when I tried growing vegetables, all I pulled was a bunch of deformed carrots.

Laura has a similar problem.  At uni, men were young, plentiful and persistent.  Now it’s a different story.

She dreams she’ll randomly meet a hot guy while out shopping.  He’ll have eyes like molten chocolate and a French name like Yves.  They’ll swap phone numbers and then – well, the rest will be in soft-focus.   shoppingIn point of fact, the only time she spotted anyone attractive in a shop, she up-ended her handbag in the aisle.  Instead of helping her collect coins and tampons off the floor while begging for her number, the guy turned away and carried on studying tea-bag prices.

Back to dating websites then.  Where she’s 34, called Emma, pretends she’s not a lawyer, and gives a fake phone number.  It’s a pay-as-you-go mobile she can easily discard.  All those phoney layers will have to come off if (or when?) when she meets someone nice.  She’ll cross that bridge when she gets to it.

Geoff is another character out of my forthcoming novel.  He’s a newly divorced doctor, and the nice pay packet no longer makes up for sky-rocketing patient demand and new government diktats every other day.  During his years working in hospitals, women threw themselves at him, and academic awards came equally fast and thick.  stethoscopeBut he’s been a GP for over 10 years now, and the sea is remarkably empty of fish.  GMC guidelines forbid relationships with patients, and he doesn’t fancy the new receptionist, even if the patients adore her.   Plus there’s a new problem now.  He can’t perform as he once did.

Geoff returns the call to the nursing home.  Bad news: 94-year old Mrs Montgomery fell out of bed again so he’ll have to visit.  She seems fine, they say, but as always the staff want to ‘cover’ themselves.

Get yourselves a duvet, thinks Geoff as he gets into his car.

Karen, now.  Men haven’t exactly been beating a path to her dilapidated front door.  No, her best friend tells her, the meter reader doesn’t count.

Newly single, Karen has 4 children and no job.  She’s still confident she’ll meet someone eventually, even if all the evidence so far is against it.

After a clear-out, today she’s headed for the recycling centre.  It’s on her way to the hairdresser’s for a much overdue appointment, via the shoe repairers and the bank.  Why spend more on petrol than you have to?  Karen doesn’t obsess about her appearance, especially when she’s busy cramming her clapped-out Toyota with bags of garden refuse, broken toys, mouldy trainers, 994-piece puzzles, and clothes that her kids have worn to death.recyclingParking her car in front of the containers, she notices a man in a green T-shirt unloading a wardrobe from the back of his estate car.  Nice buns.

He turns to face her.  It’s a Nike T-shirt, and more to the point he has a great smile.  She makes eye contact and returns the smile with a Hi, ready to talk about the wardrobe, or anything really.

He clocks her, but his smile promptly fades.  In fact he hot-foots it back to his car, driving off a lot faster than the 5 mph limit.

When she gets to the hairdresser’s, Karen is ashamed to see in the mirror just how bad her roots have got, how much garden rubbish she has on her sweatshirt and, in short, how bad she looks.

Michael knows exactly where to meet women.  After all, he’s an accountant, so he’s got it planned down to the last detail.  That’s how he does everything, even watching porn.

More to come in my novel on dating. Meanwhile why not take a moment to share your experience of meeting people? I’d love to hear your tips too.

One Good Thing about Having Surgery

Sanjay is only in his 30s but he’s had a lot of surgery, all of it since the cancer was diagnosed. That’s if you don’t count ingrowing toenails as a teenager, now best forgotten along with his pongy trainers.

As with Laura, Geoff and the other people in my novel, I made Sanjay up.  He only lives, breathes and sheds tears in my fiction.

In his opinion, the only good thing about operations is the pre-med.  That injection is chock-full of morphine.   Makes you as legless as a freshers’ night out.  There’s also some stuff to dry up secretions, so your mouth is like an African drought.  But with the morphine on board, who gives a fuck?

Then the anaesthetist gets him to make a fist.  “Now count to 10 for me.”   He never gets beyond four before drifting away.230991_2134 surgeon crop

Whatever delicious thoughts he has on going to sleep, there’s always hell to pay when he wakes up.  Last time, someone was moaning like a wounded animal in the recovery room.

And Sanjay was in serious pain.  Just because you were asleep when they plunged a knife into your neck didn’t stop it hurting like hell afterwards.

He thought of his mate Ben.  He must have been in agony for hours.  Sanjay wondered if anyone had given him enough morphine, whatever ‘enough’ means when an IED has ripped off one of your arms and a hunk of leg.  Was there was someone sitting by him, like this nurse here?  Probably not.  Just another wounded soldier, doing his best with a tourniquet and praying the MERT would show before they both snuffed it.

In the recovery room, Sanjay had the irresistible urge to sit up, but the pain and the nurse kept forcing him back down.  He had a sore throat and felt sick.  The smell of antiseptic didn’t help, nor did the bilious scent of dressings.  Nurses insisted there was no smell, but they were wrong.  Since the chemo, he could smell everything.

The moaning still hadn’t stopped.  Some poor deranged sod really didn’t want to be here.  “Hush now” the nurse said. “I’ll get you a sip of water.”

The thirst was unbearable, but all he got was a plastic thimble of water, with instructions to take a small sip.  Most of it went down the front of his hospital gown.  Miraculously, the moaning stopped when he drank the water, which was when Sanjay realized that he was the deranged sod making all the noise.

He patted his neck and shoulder tentatively through the dressing.  Strange that such a small procedure would lead to so much trouble.  Maybe it was the drugs.  It was always a bad idea to mix drugs, but hospitals dosed you with reckless abandon, with gases out of metal cylinders, and loads more stuff into your veins.  One of the anaesthetists explained it.  She was one of the new docs, a woman with long red hair and a piercing that went right through a massive freckle on the side of her nose.

She was flirting with him, he was sure.  So he flirted back, as best one could when lying down and wearing a hospital gown instead of Paul Smith loafers, Armani jeans and lucky pants.  That was when he learned about the IV anaesthetic drugs, like fentanyl and ketamine.  All the stuff to make sure you didn’t come to during the op. No wonder by the time he got to the recovery room he felt he’d gone four rounds with David Haye and had an overdose of Ivory Wave or whatever high you could get for a tenner these days.

Jeremy's scalpel

He’s hoping he won’t go under the knife again, but the cancer always seems to have other ideas.

How are you today, Granny?

old persons crossingNo matter how good a doctor you are, if you don’t look after your own, you’re right at the bottom of the class. That’s the opinion of Geoff, a 30-something general practitioner from the pages of my novel One Night at the Jacaranda.

Granny shuffles to the door in furry Elmo slippers. ‘I haven’t been for three days,’ she says, adding, ‘I’m 92 you know.’  Geoff is pretty sure she’s only 90 but Granny often adds a year or more for effect.

She doesn’t see her friends anymore.  Yet today she insists she sees them daily and plays bridge.  ‘Elsie even brought me chocolates this morning.’  When Geoff looks at the box, he sees the sell-by date is 2011.

Apart from her bowels, Granny’s life now revolves around food and meal times, but she only picks.  Geoff checks her fridge and throws out rotten pears and expired cheese.

Today she demands a haircut.  ‘You were going to be surgeon,’ she reminds him.  He’s not sure he was training to cut the three strands of white hair left on the old girl’s head, but he gives it a go.  She stands in the bathroom, clutching the sink and bending down so he can reach even though he’s no longer the small boy she read stories to.  He’s 5’11” and she’s shrunk to about 4’10”, so he practically has to kneel.

Although it’s August, there are Christmas decorations all over the bathroom, or rather the bits she can reach.  Granny has never before celebrated Christmas.  Now she reaches out with a sinewy hand to adjust the tinsel on the towel rail then looks at him proudly. ‘I’m 93, you know.’

Today is a good day because it’s only her shoulder and her constipation.  Last week it was her knee and a rash.  The week before, it was her ankle, which she sprained on VE Day 1945.   He said it was just wear and tear, so she poked him with her walking stick and called him stupid. Geoff can’t understand why her mental state fluctuates so much.  Obviously dementia has a vascular component, but how can it possibly change to that degree?

‘I’m going to do Big Poo,’ she announces.  This reminds Geoff of his son.  The difference is that five-year old Davey’s brain is still making new connections between cells.  In Granny’s case, the opposite is happening.  He imagines her brain full of holes, like Emmental cheese.  He’s glad his mother died before she got like this, even though it meant Granny lost a daughter.

She installs herself in the toilet, legs not touching the ground.  Geoff knows this because she won’t let him shut the door.

So he waits in the darkened living room, where there’s a pile of plastic bags, all neatly folded on the sideboard, a stack of old envelopes which could be useful for making lists, and electricity receipts going back to 1988.

Alte kakers.  Only Granny makes Geoff want to break into Yiddish.  She makes him want to break into the Bristol Cream sherry too.  There must be an unopened bottle in the sideboard.

Geoff remembers that alte kaker means ‘old shitter’.  As he waits for Granny, he thinks of the words patients use.  Faeces.  Number Two.  Dump.  Crap.  Ploppies.

He’s sure an hour has passed, but when he checks Granny is still on the throne, with her legs sticking straight out.

‘You know I love you, Bubala,‘ she calls out from the toilet, voice still strong.

‘I love you too, Granny.’

elderly hands

 

Related posts: 

An Evening at the Proms

Hospital Tests: Has the Doctor Got it Right?

Germs and Geriatrics

Six Characters in Search of a New Year’s Resolution

‘Am I in your book then?’

If you’re rash enough to tell your friends you’re working on a novel, they’ll be dying to know if they’re in it.bookshelf crop

If? What am I saying! Of course you’ve told them. Blabbing about work in progress may stifle the muse, but the people in your life need to know why you stay in every night with your laptop and a bag of Doritos, thumbing through old Lands’ End catalogues in the vain hope of overcoming writer’s block.

So back to that pesky question. ‘Am I in your book?’

Of course they’re not. Yet no matter how many times you reply that it’s fiction, goddammit, they expect a cameo role, minimum.

If you don’t shoehorn them in, they’ll assume you don’t find them interesting enough. So they dangle tempting revelations. ‘You do know I was George Clooney’s girlfriend/chauffeur/manicurist? And did I tell you about the time I wrestled three KGB men under water?’

I usually reply ‘Cool. But it’s not that kind of book.’

Some people plead to be put into prose. Even non-fiction. Does Michele really want to end up in the chapter on personality disorder? Now that’s serious attention-seeking.

Yes, it would be great to use real characters. There are folks I’d love to transplant wholesale into a book, where they’d take root and flourish. Sadly, I can’t put in any of the wonderful patients I’ve seen over the years, even if it would save my imagination a lot of pointless exertion.

Then there are colleagues past and present: devoted, brilliant, arrogant, disillusioned, or dead drunk. No surprise I’ve got a doctor is in my forthcoming novel. Geoff is burnt out and now, going through a mid-life crisis, he wonders if he really does make people better. I like to think he comes across as authentic. All the same, he’s not real, nor is he based on any one person in particular. And he’s definitely not you, even if you have erectile problems and a cute son with asthma.

If you’ve already written your work of fiction, you’re doomed because family and friends always think they’re in it. What part of the word ‘fiction’ is so hard to get?

Real people don’t go in novels (though there are exceptions, like Princess Margaret in Edward St Aubyn’s Some Hope). Here’s why.

1. When you finally get off your sofa you won’t have any friends left.
2. The UK is the libel capital of the world. For more on what can happen, see John Preston’s recent Sunday Telegraph piece The Murky World of Literary Libel.

Fellow writers, I’d love to hear your views.