THE REASON WHY

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.’

82 thoughts on “THE REASON WHY

    1. andy

      Her father got kicked in the third coccygeal segment by a cow and died of an aneurysm in his ventricals later that year, I heard.

      Reply
      1. andy

        But was it too late?
        The doctor moved mountains to get her into care that very day… and followed up by irritating the entire HIghland and Island Trust to act…But it worked, and though critical for a week she pulled through. And he realised that he had, for once, stepped over his invisible line, going daily to see her recover..and tell her about her father’s death being kicked by a cow.
        But that was five years ago now and the farm was today on the right road between them. And the twin bairns playing in front of the fire, as the ex-doctor wrote his blog.

        Reply
        1. Johanne LaFrance

          You had me laughing at the father dying from being kicked by a cow. Poetic justice. However, I am rooting for Arthur, the neighbour’s farmhand to get Annie’s heart.

          Reply
          1. andy

            It’s true. Arthur could have any lass he set his eye on..yet somehow he was superficial. And whilst her body said yes, her mind said no. And she had heard talk in the village that Tess the milkmaid was carrying his child when she was found under Langton Cliffs. .

  1. andy

    Yes its a nice snapshot. Readable and draws you in. Like talking to the Funeral Director at the county show last week. ( verbatim).
    “Were you overwhelmed for the last two years with covid?”
    “No. Not at all really…same as normal. But we are now..”
    “Hows that?”
    “Oh those who weren’t cared for over the past couple of years. Those who havn’t seen anyone and so given up..never got a diagnosis, you know. And the suicides, of course.”
    “Has anyone asked you about ‘your take’ on covid? ”
    “No No-one at all.”

    Reply
  2. carl297

    I can only think it didn’t win because the judges in New England couldn’t appreciate the Scots lilt to the dialogue, although I could hear the voices clearly as I read them, sassenach that I am! Loved it!

    Reply
    1. andy

      Dialect is most commonly used to ‘set the scene’..whereupon it is used more sparingly. Short story writing is usually not read out-loud and too much dialect can be confusing, it all being a word picture in the end.
      Make some more stories when you feel the urge for creativity. You have the talent.

      Reply
  3. Jeremy May

    Ah. Presented late eh? I thought it might have been Covis.
    It’s not easy being misunderstood. Ask me how I know!

    Reply
  4. Ddwieland

    That’s powerful writing, Dr. Kendrick, engaging, sad, and beautifully told. I’m not surprised it didn’t win the competition. Western contemporary society seems afraid to face uncomfortable truth and instead favours imaginary fears. Your fiction is too painfully true to fit the mould.

    Reply
    1. Dr. Malcolm Kendrick Post author

      Well, obviously I think I should have won too. But, hey ho, I do know that writing is a very subjective thing. I tried to read Ulysses once, and got to page three. Others think it is wonderful. Mind you, I only got to page two on Midnight’s Chldren. Luckily, we do not all like the same things.

      Reply
      1. JDPatten

        Have you tried “The Diagnosis” by Alan Lightman? Seems right up your alley, right? I considered quitting at the start of each next chapter. Oh, how i wish i had!
        Intrigued? I warned you.

        Reply
      2. Frederica Huxley

        Alas, I ploughed through both of those tomes! I was in my 40’s before I dared to abandon a book, having been brought up that one must read to the bitter end. Life has been far more pleasant since then!

        Reply
      3. carl297

        I hear that! Recently, for the first time, ‘Catcher In The Rye’ became available on Kindle. I stuck with it thinking ‘I’m sure I’ll get what all the fuss is about soon’ until about half way. And then I gave up. Someone once said life is too short to read bad books, or words to that effect?

        Reply
      4. Ruth Baills

        I just finished Pilgrim’s progress by John Bunyan writing style from the 16th century. Wasn’t easy but finally finished it. ☺️

        Loved this post thank you.

        Reply
  5. Vivien Stratton

    Heartbreaking and what a waste – such an unbearable way to leave the father you hate/love …. Thank you for this, I think🙂

    Reply
  6. Errett

    I have always loved how words, well chosen and concise, have the ability to move me out of my space and time—-maybe it is because of my ancesty—Irish and Scottish.

    Reply
  7. Paul Arnold

    The guilt inducing words no patient wants to hear: “I wish you had come in sooner.” The story is well done, and perhaps the best compliment is that I truly hated to see it end. More of the same would be welcomed here, Doc. ~Paul Arnold, Indiana, USA

    Reply
  8. Irene Ramsden

    She put her tiredness down to being a new mum. She took her baby to all the clinic appointments like a good mum should. Then someone, one day, looked at her and asked if she was okay. ‘ Just a wee bit tired ‘ she said. Tests were done but it was too late: She was dead within weeks.

    I’ve never forgotten this story. She was a neighbour. Very sad.

    Reply
  9. Johanne LaFrance

    If you wrote novels, I would read them. I loved this story! Having a history of fibroid tumours, including one weighing 5lbs (more than 2200 grams) that was removed in the eighties, my heart goes out to this unfortunate young woman. I hope she does not have anything more serious than I did and I hope she leaves her father behind immediately.

    Reply
  10. Barb McKay

    And lo these many years, you’ve been masquerading as a doctor – all the while hiding your talent for writing! Your easy prose reminds me of my favourite canadian short story writer – Alice Munro – Nobel prize…. Hope you’re very well – cheers from the Alberta prairies!

    Reply
  11. Lynda

    I enjoyed this short story, very moving. I had just watched you on Sapien’s Playground battling through the conversation as unwell as you obviously were. I kept thinking ‘please stop and rest’. I realise now that it was recorded in May but make sure you don’t leave things too late and be kind to yourself.

    Reply
  12. Martin Back

    Interesting that you gave your subject such a bleak background. She could have been one of those slutty numbers we see pictured in the Daily Mail sitting wasted on a doorstep at 3:00 am. The moral of the story would relate to the wages of sin.

    But you present someone who really deserves a happier ending. Is this because, medically speaking, that sort of background typically leads to the outcome described?

    Reply
  13. Corinna Lennox-Kerr

    We were in tears of laughter reading through the comments especially Andy’s impromptu, additional background and take on Annie, her Father and that damn handsome, muscle-ripped Arthur as well the comments from those who just didn’t get the plot i.e., THE END. Then sadly, all the laughter came to an abrupt halt as the maudlin comments took over what, until then, had been a fleet of fancy and a well needed break from the serious nature of all the Covid cra.!

    You certainly always manage to get the comments flowing fast and easily Dr.K. We trust that you are in fine fettle, fully recovered and enjoying life.

    Corinna and Glynn

    Reply
    1. Dr. Malcolm Kendrick Post author

      Whatever you want. The true joy of writing must be to create the scene, and characters, who then come to life on their own and become your friends, or enemies. They can carry your hopes and fears, and dreams. I greatly admire authors who can achieve this. It is a fantastic skill.

      Reply
      1. andy

        It’s true. These people you create get inside you and live there with you!
        Their lives can reduce you to tears!

        But as a medical blogger yourself you deal in writing, so it’s a natural step to just invent a quirky story using your talents. Keep going !

        If covid had one positive aspect it was that it gave me the time to write down any ideas I had, and blessed with an encouraging friend, I kept going.
        Would anyone like to read one of my short stories?
        Nothing would give me greater pleasure than to feel one has been given a once-over check up and a kindly diagnosis.

        andylowings@gmail.com

        Reply
      2. Antonetta

        Dear dr. Kendrick, You are gifted in writing, and in drawing the reader in with all that is left unsaid between the lines. In the past two years, I found that more doctors have come forward and demonstrated they were great story tellers. No exception, they first and foremost care about helping others, not about being right. Their writing, as does yours, shows a deep love of fellow man. Empaths everyone of them. Please keep it up. P.s. no problem with the Scottish (even though I am Dutch 😉)

        Reply
  14. Michelle Elaine Johnson

    Wow,! you simply must write more, its very very good I want to know more. You had me hooked as Annie looked down the gun at her father…You can’t leave us hanging hon lol. Please? Xx

    Reply
  15. Frank c

    That was interesting. I wonder how the usual people will show this to be related to Covid 19 in some way. You know that they will.

    Reply
  16. Alison Morton

    The patients you never forget. As a scrub nurse in the 1970s, I remember the middle aged woman with a massive ovarian tumour, sitting atop another neoplasm in her bowel. She lived on a farm, too……
    Thank you for this – reminding us both why we do what we do, and of how much we need to share the things we carry.

    Reply
  17. David Winter

    Extremely well written apart from an anecdotal warning. You should write a novel…you have a talent for the story telling. Hoping your own malady is responding and you are chipper.😀

    Reply
  18. Heidi Dawson

    I love your writing – this is very different to the usual acerbic blog that
    I so enjoy though.

    Beautifully written and haunting – I suspect there’s no happy ending to this ‘story.’

    Heidi

    Heidi Dawson
    CEO/Lead Facilitator
    Glint

    07887 613670
    http://www.glint.org.ukhttp://www.glint.org.uk/

    [cid:image001.png@01D8B894.8584E7A0]

    Moments of Light Ltd, t/a Glint, a very social enterprise
    Company registration no. 8422619; Registered Office: South Cottage, Legsby, Market Rasen, LN8 3QR

    Reply
  19. Marguerite Harris

    I love the character — she seems so real. I was engaged right away… please write a novel with someone similar as the main character, if not Annie (sob) then someone like her!! Wonderful!

    Reply
    1. Gary Ogden

      Margurite: I fully agree. Dr. Kendrick has a fine and rare talent with the language. Writing good fiction is not an easy thing. Most of it bores me to tears, but this short piece is engaging and riveting. Bravo, once again!

      Reply
  20. David

    Slightly off-topic, but relevant to a much earlier blog, I came across this:

    https://www.ghacks.net/2022/07/31/who-wrote-that-reveals-authorship-on-wikpedia/

    Personally, If I’d been libelled by an online encyclopedia, and knew who’d committed the offence, I’d consult a lawyer about seeking recourse. As chance would have it, London is the world’s ‘libel capital’. English defamation law is it seems considerably more ‘claimant-friendly’ than it is in countries like the USA.

    Reply
  21. Jill Leslie

    Oh golly! I am right there – in that barn! Biting wind and snow too! Now that we are in N. Yorks and live nextdoor to a farm (sheep and dairy cattle) I got to “help” with the “pet lambs”. I had to accept that “where there is live stock, there is dead stock” – not easy and more than once, had a lamb die on my lap, thanks to any one of the many possible infections that they can pick up. I also have a dearest friend, recently (and belatedly) diagnosed with ovarian cancer. Yes please! We want to hear more about this “poor lass”. You are a born story-teller! Thanks so much.

    Reply
  22. Kathy Guimas

    Hi Malcolm,
    I really enjoyed reading this piece, very evocative and humanly written, I would like to read more.

    Kind regards Kathy

    Sent from Kathy’s iPad

    Reply
  23. John Anthony

    You have a talent for writing. No doubt. I love and agree with most of the comments left by your other followers.

    Reply

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