This piece appeared in World
Medicine, Oct 18th 1980.
I am indebted to Andy Wrathall, JTS collector, for sending me a photocopy of the article, and also the Staple 21 piece from 1991 which I am putting up at the same time — GL, July 2006
A FIGHT FOR SURVIVAL IN THE NHS JUNGLE
We dress it [general practice] up as primary care, call it a vocation, and train people for it. But some of the customers see little improvement. One articulate patient, novelist Jack Trevor Story, describes how general practice in 1980 can appear to the unlucky punter.
"The ills of the human body," said this doctor in Ilfracombe, who had just discovered that I had been suffering serious heart failure during all the weeks that my doctors back home had been prescribing tablets for asthma. "The ills of the human body are too subtle, complicated and vernacular to be treated like something wrong with the lawnmower."
My God, yes, I thought. All those terrible nights hanging like crucified by my elbows over the bed headboard and trying to rattle enough breath into my lungs to stay alive or just to get to sleep so that if I died I wouldn't know about it. The terrible thing was it was not my usual nervous asthma—there was a horrifying absence of wheezing, of good, familiar, usual things. I had never had enough asthma to stop me fucking or running or rowing, gardening, standing on my head. The trouble is I made the mistake of mentioning asthma to this doctor. I can't really call him my doctor; one never knew which doctor one had the good luck to be given on any particular evening. Our local clinic is like a game of bingo.
"Wass your name, duck? Oo yes, I got it somewhere. Doctor who? No, you can't see him for a fortnight. You go and sit over there—they won't be long, they keep getting lost..."
In order to maintain some kind of liaison between doctors and punters we have what appears to be a bunch of happy-go-lucky charladies (receptionists) whose job it is to more or less run the town, medically speaking. Some are friendly enough and do quite a lot of the diagnosing themselves in a cross-fire of waiting-room chat with nothing spared. But some—and particularly Mrs Blue—have illusions of Florence Nightingale grandeur. This gorblimey elite represents that seldom mentioned syndrome of the renegade working class bureaucrat, the lowly, illiterate, underprivileged peasant with a severe inferiority complex who is suddenly given permission by the state to put the boot in. Bailiffs, policemen, warders, and tax ladies are made of the same traitorous stuff.
"No, dear, whoever told you that was wrong. I don't care what the Family Practitioner Committee said, they're wrong. Now listen, because of where you live you have to go to Dr X or one of his partners—you don't understand the rules. No, you can't see DrY..."
That was Mrs Blue. Later I learned, that this Peggy Mount of a lady actually ran the entire clinic (with a little knowledge and the force of aggression) and although I met and joined and signed up with a most understanding young doctor (by approaching his wife) who furnished me with a specialist and twenty-one drugs a day, our female tyrant effectively put the boot in and I was left with a box full of-drugs, two specialists' reports, Dr Y’s notes and advice—and no doctor.
But to get back to my own personal murder case, supervised by this relay of cheerful chaps to whom you must never mention asthma or even chilblains. Inside their head they have a list of stereotyped illnesses ready to attach to the patient at the first smoke signal. I had in the past taken medicine for wheezing—going back to Pye, Murphy and Marconi in the 1930s and 40s and early 50s when you breathed in a lot of resin-cored solder fumes—medicines like ephedrine (horrible stuff that makes your joints buzz) and Rhybarvin inhalent and finally over the past six or seven years Ventolin. Like one whiff once a week and not even -carrying it on holiday. In other words, I no longer have asthma except sometimes in the mind.
Then why did I mention it at all to my man? Just to bring him up to date, that's all. Too bad. From that moment, and for the four months that followed, my failing heart was merely asthma. It could have been worse, It could certainly have been worse; it could have been chilblains or that fly in the throat that I used to take to Dr Hanton in Cambridge all through my teens.
For two years I had travelled up and down the fifty miles to my GP in Hampstead but now I was forced to do something local. In early March my cold had turned to a lung infection and I wanted to fill the local doctor in. About me, I mean. This local doctor is really a composite of three individuals allocated randomly by the charladies each time I visit.
"My Hampstead doctor always told me to go to her as soon as my phlegm changed colour—I get pleurisy and sometimes pneumonia. Usually pleurisy."
The doctor turned right round in his chair and looked at me for the first time. His usual behaviour pattern is somewhat different. He doesn't, for instance, chat or mention the weather or ask who you are or what you do for a living because he has already got all that from the charwomen out at the desk. I say, "Good morning, how are you?" Without looking up he snaps: "Yes?" I say: "I'm afraid those breathing tablets are a waste of time. I'm dying." He says: "No no. I mean why are you here? What do you want? Why have you come to see me today?" Piss off, is what you want to say, but instead you wait while he runs through the illnesses that he has already allocated to you, promises to consider a second opinion in four weeks time if the new prescription has not already killed you and points to the door.
My mention of pleurisy in March brought him to his feet in a flash of triumph as though at last he could prove that everything, every idiot thing he had done since I was daft enough to sign on with him, was irrefutable medical science.
"You have no sharp pains in your chest? Tell me where you have the pain. Does it move? You have not mentioned this before. Believe me, Mr Story, you have not got pleurisy."
I know I haven't got pleurisy. I didn't say I'd got pleurisy. I am trying to mention my tendencies as a fairly repetitive human body so that it might help his diagnosis. This point is far too subtle to explain. By now he is waving my X-ray, chest X-ray, in front of my face.
"Your lungs are perfect. Your heart is slightly enlarged. It is nothing. This is not an illness. It is your age. Most elderly persons have this. Your illness, Mr Story, is inside your mind."
Through March, April, May, my heart—as we now know—got worse; my work stopped for I could think of nothing funny to write and on June 6 I got a doctor's certificate to show the employment office when I was too ill to sign on for my non-existent dole and non-existent DHSS benefit. (Writers don't get them.) The certificate said I was suffering from bronchial asthma and osteoarthritis in the foot (heart failure, water in the lungs and water in the feet).
I was about to die and I knew it and Elaine knew it. In desperation Elaine went to the Citizens Advice Bureau who advised her to get me to a specialist no matter what. It seemed hopeless. I had already sent off a form for an appointment to see a hernia specialist at Northampton and had been given a twelve month wait. We became suicidal but also we determined to fight back.
"Let's get married," I said. This is perfectly sequential.
The health service, particularly the Florence Nightingale charladies in charge of the doctors, were treating Elaine like shit, partly I believe because of our forty-year age difference, well publicised by press and TV at the time of my Arts Council residency, partly because we were sleeping together unmarried, but mostly because these part time clinic crones are trained to stop sick people from calling out doctors and to force them to drag themselves to the clinic. One desperate dying day Elaine rang them up.
"No, dear, you can't talk to the doctor and what's more we don't think there is anything wrong with Mr Story or he wouldn't be able to keep coming down here." Elaine has got this conversation recorded and dated—it lies between the day the doctor (Mark 1, 2 or 3) said my heart and lungs were perfect and the day I drove 200 miles with my auricles fibrillating at a high rate and my legs swollen up to my knees; the day my doctor (Mark 1,2 or 3) smiled at my tiresome old heart attack and wished me a good drive. But this time he had given me a new tablet—Lanoxin.
"Whoever sent you out of his surgery like this must be out of his mind," said my Ilfracombe man. By a supremely lucky chance I had gone on holiday and got out. "I want you in hospital or I want you to stay in this bed and not move. How many of these are you taking?" This was the Lanoxin.
"One a day."
"Treble it—let me see you take one now."
There is a curious flaw in the system and it may be worth your while making a note of it. After destroying our life throughout the spring and summer of 1980 with all my cries for help unheeded and their cryptic "get stuffed" and Elaine going to pieces, there came a morning when she had forced herself into the surgery with me and insisted on Doctor (perm one from three) finding me a specialist. She is only small and very Geordie and we had already discussed suicide and it was now or never if we were to survive.
"But he has seen a specialist already and he is perfectly all right." He looked up his notes (they keep notes) and showed us the day I went to see the cardiologist at Stony Stratford clinic during the winter and was pronounced fit and well and with an okay ticker. It was, of course, a lie. If you fail to keep the appointment with the specialist, the GP—if he's thick enough—assumes you have been passed as fit.
On that day of the consultation my wife Ross was dying and Elaine and I were with her in the cottage hospital at Hawkhurst in Kent, turning her over and over to relieve the pain.
Doctor (One-to-three) was offended. "But you must have made another appointment!"
People with stereotyped heads and little insight, sensibility, or human understanding but with just sufficient memory to pass exams are not likely to appreciate human priorities; all they have are rules and lady gauleiters to carry them out.
So whatever you thought of my Guardian column, my bits in Punch, my fifty novels, my ever-enduring love for Maggie and whatever other snippets of me you may have come across while I was living, it has all ended.
People say, why get married to Elaine after eight years living together? I write for Punch and I see all these little cartoons with some lonely missionary tied to a stake and savages dancing round him—believe me, given the chance, that man would marry anybody. He needs a friend. My wife and I both detest God and religion and what it stands for, yet somehow this summer getting married seemed like Custer's Last Stand. God is insufficient.
Also I want Elaine to have a bit of status in this phony world so that she can take care of my archive when I'm dead with some authority and tell people like Mrs Blue to fuck off. Most of all, though, we have been through hell together, have died together. Yet, between the cracks flowers have grown.
"Have the poppies come out?" I heard Elaine ask her mother on long distance phone from Devon at a time when it seemed we would never get home again.
There was a time when I was being totally neglected by these doctors, when I had not sufficient stamina to pick a book off the floor, when I was so miserable with weakness and gasping for breath, when I had driven 100 miles up the Ml to do a public reading because we needed the money, using my right foot on the clutch because of gout (April 24, Mansfield, Notts) when, quite suddenly and all at once as it were, I heard Elaine whistling. She was in the kitchen and I had never heard her whistle before. It was a strange little sound and I went and found her and she told me that she had been learning to whistle because I had stopped. I think that and asking after the poppies were the saddest moments in my whole long life.
We got married for £28 and no licence with one day's notice in Hastings on July 28, 1980. A few laughing daughters happened to be around. We got married because Lainie was the only one among our friends and relations who had detected that I had stopped breathing. That my spirit had died.
One day her sister Dianne, a pretty, punk girl with cerise hair who came down to represent the Hepple family in Ryhope, was helping with the cleaning on one of those awful post-marriage mornings in my son's cottage at Bodiam Castle at a time when I still could not drive a car or walk without kicking the ground. It occurred to me that everybody knew more about my approaching death than I did and I listened at the kitchen door.
"I can whistle now," I heard Elaine saying, cheerfully.
It was a terrible kind of progress report.
My whistling is missed for it is lifelong, unconscious, and began with the thirty-two bars of Jimmy Dorsey's Backbeats on the old Parlophone Five Pennies record in 1936. Sometime in the spring if had ended. Elaine had determined to take it over; together with the gardening, the animals and ducks all taken in her stride with the washing machine and the charting and selecting of my twenty-one drugs a day—all her new responsibilities as a young 24 year old with her very first husband and home. She has shuffled me around the shops in strange towns because we were too frightened to come home and be alone, explained my stuttering speech to strangers and nursed me through what I can only imagine to be the equivalent of serious shell-shock.
"You are in a state of mourning for the death of your old self," Heather Knight of Hawkhurst explained when I was crying in her surgery. She promised I would finally adjust to a life on drugs. Late nights Elaine and I discussed ways of committing suicide and she promised to help me if it became necessary. I lay for hours working out ways of executing the ignorant men and their illiterate clerks who had so blithely sentenced me to old age. They seemed to think that heart attacks at 63 were good news and part of being stereotyped like them. Not so. In front of me this year was sailing, hang-gliding and six months work in San Francisco.
"You must sue them," said Nigel, who is a barrister and professor and, luckily, one of my family. Gathering the evidence has given us a new interest. We have at last got home again and are picking up the pieces (particularly pieces of evidence). At night I practice my public reading to an audience of one.
"You'll get a new telly series, Jack," she said last night.
"You're just saying that." (Don't run for a bus, says my heart. Don't dive into cold water. Sex, thank God, is okay.)
"I'm not supposed to tell you this," said my new wife then, "but ATV are interested in your Road to Wigan Pier on a Moped—Pat Ingram phoned up."
"You're lying," I said. This news was too good.
"No I'm not," she said. "You are going to live a normal life and I am going to have a baby." Then she started whistling. I don't know what the tune is but it breaks my heart because I think she's making it up. •
Photographs by Keith Morris
Copyright © the estate of Jack Trevor Story 2006. Not for
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of the author's heirs. Permission for use of this material can be
obtained through Jackie Edwards (Story), Peter Story, Lee Story or
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