24th August 2022
As a change in direction, I thought I would share a short story I wrote. This was an entry to the New England Journal of Medicine competition. This one under the theme “A patient who presented too late”. It did not win, but I thought some of the readers of this blog may like it.
THE REASON WHY
The ewe was suffering, lying on its side, its bleat reduced to a painful gasp. ‘It’s nae coming out father.’ Annie wiped the blood down her trouser leg.
He hurled his shovel to the ground in a rage. ‘Whit have you done wrong this time!’
‘Nothing I…’ She stumbled away from him as he hauled open the entrance to the pen. He glared down at the sheep, struggling to give birth. ‘We lose another one, and I’m telling ye.’ He bent down to examine it. ‘Wrong way round. How could you no’ see that?’
‘I…should we call the vet?’
‘Vet!’ He looked ready to explode. ‘Do you ken how much a vet costs… do you?’
‘But it’ll die.’
‘It’s nae worth anything.’
‘It’s… I don’t know.’ Her shoulders slumped.
‘Oh, poor wee Annie disnae want to see the ewe die.’
Annie touched her own stomach lightly, tenderly. ‘No, I.’
‘Get the gun.’
‘Can you no just get it out, please… father?’
‘Dinnae be an idiot.’ His voice was a club. ‘Gun, now. You shoot it, and skin it. We freeze it and eat it ourselves.’
She stumbled out of the barn, into a fierce wind. Rain and sleet blowing down from the North, falling in sheets from heavy dark clouds. The hills above were now laced with wet snow. The courtyard glistening, moss covered, slippery. The house was freezing inside. The gun in a cupboard below the stairs.
She pulled it out and made her way back to the kitchen. For a moment she held the gun up, squinting through the sights. She could make out her father’s angry back through the dirty window. He turned, and for a moment, it was as though he were staring straight at her. But she knew he wouldn’t be able to see her, standing alone within a darkened room … Watching, heart beating too fast.
‘Hey Annie.’ Arthur was striding along a path beside the field. The sun was high, it was a lovely day, with small flowers studded amongst the grass. Below her the Cromarty Firth shone like a steel plate, as the sea cleaved the hills on either side. A lark was singing frantically above her, hovering high, a fluttering dot. She loved the early summer up here.
She was in a t-shirt and jeans, trying to fix the tap that fed a trough for the cattle. It was old, rusted, they badly needed a new one. Her fingers were already cut in several places.
‘Hello Arthur.’ She didn’t look up, but she knew he was studying her with interest. She pulled the t-shirt more closely round her neck.
‘Do you need a hand?’ He worked at the farm next door. She had watched him from a distance. Driving the tractor, chatting with other workers, talking to his cows. Yelling at them. Kicking them when they wouldn’t move, then laughing. At night, sometimes, she thought about him.
‘Just look at you.’ He had come up close. He took one of her hands in his, examining it with care. ‘What are you doing to yourself?’
‘The tap needed fixed.’ She allowed her hand to rest in his.
‘That piece o’ rusting rubbish?’ He laughed. ‘You’ll no fix that. You need a new one.’
‘Father says we cannae afford it.’
‘Aye… well I’m sure he did. I’m sure he did.’ For once, there was no trace of humour in his voice. ‘What about you Annie?’
‘Whit do you mean?’ She flushed.
‘Up here, by yourself, stuck wi’ your gloomy dad. What does Annie do?’
‘I work…’ She glanced round, making sure her father was nowhere nearby, watching. ‘The farm needs me, after mother died.’
‘I hear you have a brother. Big lad.’
‘Aye, but he… he left. He hasnae been back for years now. He works in the big city.’
‘What, Inverness. Aye, the great big city. Even got a MacDonald’s, might just be the centre of the World. Mind, he could walk back in a day… if he wanted.’
‘Well, I don’t know.’ She had no idea what to say next. She wasn’t good at conversations. She didn’t have many. An awkward chat about the weather over a cup of tea, down at the kirk on a Sunday. A half-hearted promise to visit from one of her mother’s old friends. Nobody really wanted to come to the farm anymore.
‘A bonnie lass like you.’ He touched her shoulder lightly. For a moment she allowed herself to lean in towards him.
‘No…No. I cannae stay.’ She leapt up.
‘Hey, hey up Annie. I didnae do anything.’
‘I …I have to go!’ She gathered her things together furiously into a leather bag, then almost ran up the road. Arthur watched her. He always noticed when she was in the fields. Working the dogs, driving the tractor, hair blowing in the wind like some Pictish warrior queen. That long vanished race who once roamed these lands. She always looked to be concentrating furiously, passionately, on everything she did. She made him feel alive, and awkward, like a wee boy…
…This night, the pain was worse than ever, grabbing at her stomach fiercely. Her periods had almost stopped and… and she reached down to touch her stomach. It was definitely growing. ‘You’re getting fat. I cannae have you slowing down, not now.’ Her father had snapped.
How she wished her mother was with her to offer some comfort and kindness. After she died, her father had become so different. Angry, shouting, red faced. He would be sitting slumped in front of the coal fire now, whisky bottle close to hand, no doubt. Staring at the flames.
Sometimes though. Sometimes he came to her room, and he was different then. She reached down to scratch the head of her Bramble, her collie dog. Bramble licked her hand.
‘Whit can I do lassie.’ Annie looked down into Bramble’s adoring eyes. ‘Whit can I do.’ She closed her eyes tightly as the pain caught at her again. She wondered about going to the doctor. Then she thought about her father finding out. What if it was a child… what if it was a child?’ The thought filled her with desperate longing, and terror. She knew you could get tests, but…
‘How many this morning.’ I felt the need for an early finish. It had been an unrelenting week.
‘Sixteen, the usual.’ Jill, the receptionist, brought my list up on her screen. I was the on-call doctor, starting early.
Five regulars, who were all depressingly regular in their visits and vague, never ending, untreatable complaints. ‘Who’s that first one, never seen her before. Anne Pierce? You know her?’ Jill had been born and brought up locally, she always seemed to know everyone, and everything about them. Mother to every waif and stray.
‘That’s her, she was waiting when I opened the door. Arthur Mackenzie brought her down, I saw him in the car, pretending he wasn’t watching.’ Jill kept her voice low and nodded towards the only patient in the waiting room. Hands gripped together; head down, staring at the floor. Hair dragged back a painfully tight bun. ‘She lives with her father on High Range farm, poor lass.’
‘Poor lass? Tell me more.’
‘Her father is…’ Jill flushed.
‘He is, what? Is this the secret service?’ I whispered into her ear.
Jill giggled. ‘Not very nice.’ I knew she would say nothing more. Miss confidentiality. Even though I was the doctor.
‘Well, if she’s a farmer, it must be something serious.’ Famers were notorious for putting up with anything. Bone broken after a fall… ‘Just a wee break, strapped a couple of bits of wood round it, hurts a bit when I walk.’ Or coughing up blood. ‘Just a wee cough, had it three years. Took some of the antibiotics we use for the cattle. Thought it would clear up doc.’ Yes, well, everything clears up when you’re in a coffin.
Annie had entered the room without meeting my eye. Her history had been simple. Abdominal pain, a bit of swelling. No periods. The pregnancy test I gave her to do was negative. She had been jumpy, wary, an injured bird. I watched the silent spasm of pain on her face as she got up on the couch.
Her abdomen was certainly enlarged, but it didn’t seem like any pregnancy I had seen before. I put my hand on and pressed down. It was like pushing on a car tyre. Hard, very hard. I tried to find an edge, but there was none. A mass was literally filling her abdomen. It must have been the size of a pillow. This was one of the few times when I had absolutely no idea what to say to a patient.
‘Are you okay doctor.’ My attempt to hide my emotions had failed completely. She seemed more concerned about me than her.
‘Yes, yes, thanks. But I think we may need to get you looked at.’