The child’s eardrum was bright pink.
‘Has Mia been swimming recently?’ Cat asked.
‘Tuesday – she’s just started.’
‘Surprise, surprise. I get a steady stream of children with ear infections after they’ve been swimming. But this will clear up on its own. Give her some Calpol if it hurts – she doesn’t seem unwell in herself and the other ear is quite clear, but if she starts to run a temperature or won’t eat, bring her back. All right?’
‘Well, no, not really … Dr Sparks always gives her antibiotics for anything like this. Can’t she have some penicillin?’
‘She really doesn’t need it at this point and we try not to give young children antibiotics for minor infections – the body deals with them very efficiently.’
The mother sighed and showed no signs of leaving. ‘I suppose this is all about cutting costs like everything else. We used to ring and a doctor would visit but not any more.’
‘Mrs –’ Cat glanced at the computer screen.
‘Browning. And the doctor always used to know you – know your name and everything. Not any more.’
‘I understand. The trouble is I’m just a locum, filling in for Dr Sparks while she’s ill, so I don’t know all the patients. I’m sorry. But as I said –’
‘Could I just have a prescription for the penicillin, give it to her if she needs it? Save us having to come back.’
‘I really don’t think she’ll need it, and it isn’t a question of money, it’s because too many antibiotics given for minor things mean they won’t work if they’re ever needed for something serious.’
‘There are plenty of different ones, aren’t there?’
‘It’s the same principle, Mrs Browning. Now, Mia will be fine – but come back at once if you are worried, and if you do, tell the receptionist that I said you were to have a quick-access appointment the same day.’
She could read everything into the woman’s back as she went out, pushing the child in front of her. How many times did it happen a day? She didn’t blame the mother. The rot had started thirty years ago, she thought, pressing the buzzer for the next patient. We thought everything needed antibiotics and nobody thought of tomorrow – which is now today.
‘Mr Leeming? Good morning, I’m Dr Deerbon. Come in and take a seat.’
‘Where’s the other doctor? I don’t like seeing someone new every time I come.’
Another day in the life of a locum, Cat thought, smiling her sweetest smile at yet another grumpy and dissatisfied patient.
She had started doing locum surgeries a few months earlier, when her finances had taken a further nose-dive and her role at the hospice had been downgraded. There was nothing else she could do, there was plenty of locum work, and she took everything she could get. It was well paid, but it was also very unsatisfying. She understood the complaints of a patient like this one, with chronic problems. He wanted, and was entitled to have, an ongoing relationship with one GP, though he could not be guaranteed to see that doctor in an emergency. With a locum, he had to start again, detailing his symptoms and the history of his illness, waiting as Cat tried to absorb a screenful of complex notes. Most of the patients in these surgeries had minor complaints. She was happy to see them, even if a good number could have treated themselves, but she had no relationship with them, did not know their families, their personal and domestic problems, all of which helped to form a full picture of human beings in need of medical care. Once …
She shook her head now. Stop harking back to the good old days of general practice, she had to tell herself half a dozen times a day. Things have changed and they’re not going to change back. Get over it.
Perhaps one patient in fifty she saw now had something serious or unusual, and therefore interesting and perhaps challenging. But in that case, she would hand them over to one of the permanent partners in whichever practice she was working that day, and hear no more. It was frustrating and she enjoyed her job a great deal less than she used to, but it was a job, she was never short of requests to take a surgery for a day or a week, in Lafferton and further afield. Bevham, where she was today, had a particular shortage.
In the corridor on her way out, she bumped into one of the senior partners.
‘I can’t tell you how grateful we are, Cat – it was becoming impossible, with one on maternity leave and one ill. You’re a godsend. How are you finding us?’
‘It’s a lovely practice to work in – very efficient support staff too.’
‘Any buts?’
‘Only the usual every locum complains about. But no, not really. I’d rather work here than in some others I won’t name. Only one thing concerns me, and as it’s fast becoming the situation everywhere, there’s no point in bothering about it.’
‘What?’
‘This is a large practice, even with two doctors off. So like all large practices, you tell patients they can book in with anyone, they don’t have to wait to see their own GP. And you only take appointments for up to a fortnight ahead, which means –’
‘I know. The most popular doctors are always booked up. But there’s been a lot of research on this and people really don’t mind seeing any doctor if that means they can get an appointment quickly.’
‘Sometimes. If your child has raging tonsillitis it doesn’t matter who you see, but if you’re, say, a cancer patient with ongoing problems, it makes a huge difference to your morale and confidence if you can see your own doctor every time.’
Clare Boyle leaned against the wall. She wore her spectacles on a cord round her neck and had a permanently distant expression. Perhaps it was just her bad sight, Cat always thought, but it made her seem haughty. She could be quick-tempered with the reception staff too.
‘You’ve spent most of your time as the old-fashioned sort of GP, night calls and all. Those days are gone. With everyone’s notes accessible on the computer system –’
‘Clare, sorry, another time, I’ve got to meet my daughter from the bus.’
She fled. The computer system was fine but it did not give seriously ill and anxious people a personal consultation and reassurance. She would fight for the principle that a good doctor can often heal simply by being there and listening. Well, so be it, she was only a locum. She worked the surgeries she was offered and went home. Which was part of the problem, on both sides. Now, when she clocked off, she never left feeling satisfied that she had made a difference.
She was not in fact meeting Hannah from any bus, Hannah was staying with a friend as she always did on Tuesday, while Cat went to St Michael’s Singers practice. When Richard and Judith were at home, Felix went to them at Hallam House, but now, and for however many weeks they were in France, Sam would babysit. He took his role as babysitter so seriously and responsibly that she sometimes wondered what she wasn’t being told. When she got back, he was always in bed reading, the kitchen had been tidied and the dishwasher loaded, Wookie and Mephisto fed. Sam earned his money.
She had a couple of hours in which to go through the score for tonight’s practice. The Delius, which she disliked, was not giving them many problems but a work by Peter Maxwell Davies certainly was. Most of them were up to the challenge but she doubted if she was – it would have to be a case of clinging on for dear life to the person standing next to her.
Not long after Cat got in, Felix was dropped off by the family with whom she shared school lifts. Sam walked from the bus stop a little later. Felix was allowed toast and Marmite and half an hour of television before ‘homework’, Sam the same, plus a mug of tea, but then he hung about, first wandering in and out of the kitchen, then going up to his room and coming down again and finally, swivelling round on one of the counter stools. Cat looked up twice from her score. He went on swivelling, then stopped and smiled at her sweetly.
‘What do you want, Sam?’
‘Nothing. Just, you know, being here.’
‘Right.’
‘Hanging.’
‘Fine.’
‘What time are you going out?’
‘Twenty past six. As ever.’
‘Cool.’
‘Do stop that. Stay here by all means, be my guest, but do not swivel.’
‘Gotcha. Mum?’
So there was something.
‘Here I am.’
‘When’s Uncle Si coming back?’
‘I’ve no more idea than you have – nor where he is or what he’s doing.’
‘Truly?’
‘Absolutely.’
‘Don’t you think it seems odd?’
‘Not really. It’ll be something to do with SIFT, I suppose.’
‘Only he usually sends a message to one of us. At some point. From somewhere.’
‘Police for you. You know how it is, Sambo.’
‘Do I?’
Cat put down the pencil with which she was marking her score. ‘Are you worried?’
‘Are you?’
‘Yes, a bit, I always am when he disappears, but worrying doesn’t help and chances are that he’ll just pop up again, say nothing, and carry on as if nothing’s happened. God knows what some of these jobs are about, but it’s what Simon loves, it’s his life, always has been. We can’t stop it.’
‘Maybe he ought to think a bit more about – you know. Us. And Rachel.’
‘He does think. But the job always comes first.’ ‘Time he married her.’
She hid her surprise. Sam had never made such a remark – she hadn’t thought he had registered Rachel much, though he had always appeared to like her when they met, which wasn’t often. It occurred to her that her son was in many ways as deep a pool as her brother.
‘You’d better get going.’ Sam swung off the stool. ‘I’ll start Felix’s supper.’
‘Make him finish –’
‘His omelette and drink his milk and do his teeth and wee and …’ He pushed her gently from behind. ‘Go.’
‘You’re taller than me now, Sam, did you know that?’ ‘Have you only just noticed? I’ve been taller for months … years even. Decades. Centuries …’ Gradually, he shunted her out of the kitchen into the hall.
‘OK, little bro, I’m coming to get you …’
Squeals from the den.
Just after nine, Felix was asleep and Sam had done most of his homework. He had to finish an essay, which was already late, on manifestations of evil in Macbeth, but decided it could wait another day, until he had fine-tuned his excuses, giving him an hour before his mother would be home. He opened up the file on his laptop called ‘Geography – Maps and Charts’ and began to scroll down the individual entries for guns, with detailed specifications and a photograph beside each one.
He knew most of them by heart now, but he liked to test himself on the detail, and make comparisons. He became so absorbed that when the car headlights flashed into the drive, he had to make a leap to close down and head fast for the bathroom and his toothbrush.