[This stand alone story serves as a sequel to two previous stories about Dr Scrooge and thus contains a few spoilers of those previous tales. If you are both fortunate enough not to have stumbled across those episodes and foolish enough to want to read them before this one, the whole seven part story, starting from the beginning can be found by clicking
As with the former tales, any similarity here to real people or events is entirely deliberate. Names, however, have been changed to protect the contentious.]
IT’S A WONDERFUL GP LIFE
In which Dr Scrooge is visited one final time.
It was a little after 6.30pm on Christmas Eve and Dr Ebenezer Scrooge had just ended the final telephone consultation of the day. A receptionist appeared at his open door holding a plate on which sat a sorry looking mince pie. Careful to keep her distance, she placed it carefully on the end of the examination couch, positioned as it was, just inside Dr Scrooge’s room.
‘Is there anything else you need Dr Scrooge?’, she asked from behind her mask. ‘Only, if it’s OK with you, I’d like to get off promptly this evening. Will you be all right to lock up?’
‘Yes of course Alice, you head off’, Scrooge replied, ‘Thanks for all your help today. And have yourself a very Merry Christmas.’
Scrooge himself though was not much in the mood for merriment. It had been a long hard year during which much of the job he had loved for so long had changed beyond all recognition. So great had those changes been that at times he felt as if he was working in a glorified call centre. None the less the work had been difficult and intense with on call days being as busy as ever. Disappointingly though, as far as he could tell, there had been little recognition of this from members of the public, many of whom it seemed thought that GPs had shirked their responsibility during the pandemic, imagining perhaps that they’d spent the whole of the summer on the golf course.
This could not have been further from the truth. Apart from that incident involving a lemon, a stained glass window and the irate members of the parochial church council, Scrooge hadn’t picked up a golf club for many years. Even so the profession had been on the wrong end of much criticism and, on at least one occasion, had being branded as a national disgrace in the papers. Though he knew it wasn’t true, such allegations still hurt. But now at last he had a few days off though, with no family of his own, spending that time all alone wasn’t something he was particularly looking forward to. Furthermore a letter of complaint had arrived that morning that had served to dampen his spirits still further. He’d been expecting it for a while and, as someone who in recent years had found it easy to be self critical, he couldn’t help feeling the complaint was wholly justified.
‘I could have managed things better’ he thought to himself. ‘If only I was a better doctor – it just wouldn’t have happened if I’d done my job properly.’
‘Sometimes I don’t know why I bother’, he said aloud as he stood up from his desk and, ignoring the mince pie, made his way out of his consulting room. He stopped by the waiting area, empty now as it had been most of the year. He missed interacting with a full waiting room, greeting those he knew who were waiting for their appointments with either himself or others within the primary care team. On occasions, in the hope of lightening the mood a little, he used to like to share a joke with those who sat anxiously waiting their turn to be seen. It must have been at least nine months now since he’d bent down low to look under the chairs when the patient he’d called hadn’t been there, suggesting that they were hiding from him there. This had become something of a habit of his but it nonetheless usually made a few of those waiting smile, and it never failed to amuse Scrooge himself!
There were only two chairs left in the waiting room now. Scrooge walked over to one of them and sat down. He starred at the TV screen mounted on the wall. Used to convey information to those gathered, he mused to himself that regrettably it only ever showed repeats. Scrooge remained in a melancholy mood as he sat and considered the past year.
It had been one in which he had been urged, not without good reason, to distance himself from those who had sought to come to him for help. But, he feared, this had, as a consequence, resulted in his seeing the needs of his patients in isolation and that the care he offered them had inevitably become less personal as a result. This he felt had been as detrimental for him as it undoubtedly had been for his patients. Understandably focused on the coronavirus the world had sometimes failed to see the bigger picture. Lost in the woods that could could no longer be seen, and confused by the trees that had crowded its view, the world had, he sensed, in its desperation to keep on living, forgotten the meaning of what it was to be alive.
And it wasn’t only in the world of medicine that things had changed.
Last week he’d been shopping. First he’d parked in a multi-storey car park where, for reasons that were inconceivable to him, the top three storeys had been closed off. This had been justified as being ‘due to Covid restrictions’ but, to his mind at least, such action had only succeeded in ensuring people had to crowd into the two remaining lower levels. Then he’d heard a father outside a department store reassuring his little boy that his mother wasn’t dead but had simply popped into a shop. It’d have been funny if it hadn’t been so sad, evidence of the crippling and excessive anxiety some, including children, were experiencing. And then, to top it all, he’d visited his local branch of Waitrose and bought fennel, dill and some apparently ‘essential’ orzo, three items that a year or two previously he’d never heard of. What, he wondered, was the world, and he, coming to.
‘What’s the point? I’m a failing doctor, in a failing system in a failing world. Time for me to call it a day. If I write a letter of resignation and give in my notice now, by the summer I’ll be free of all of this. And the practice and the local community will be all the better for that!’
His mind made up, Scrooge started back to his room in search of some headed paper. But as he did so the TV screen burst to life and the figure of an elderly man appeared surrounded in swirling mist. He was dressed in a old duffel coat and he was sporting a trilby hat. From within its confines, he tapped on the TV screen in order to attract Scrooge’s attention. Not surprisingly, he was wholly successful in his endeavour.
Scrooge turned back to address the figure, less startled perhaps than some might have expected him to be on account of his previous experiences with ghostly yuletide apparitions.
‘Oh for goodness sake. Not again!’ he started. ‘Who is it this time? “The Ghost of The Christmas We Never Expected”, “The Spirit of the Times”, or, perhaps “The Spectre of The End of Civilisation as We Know It”!’
The elderly figure seemed a little taken aback but, nonetheless, began to make his way awkwardly out of the TV. Before long he was standing in front of Scrooge, smiling broadly.
‘None of the above!’, he replied. ‘My name’s Clarence, and I’m your guardian angel, allocated to you now that George has no further need of me.’
Scrooge was, momentarily, lost for words.
‘Clarence? What kind of a name is that for an angel, guardian or otherwise. And who’s George when he’s a home?’
By now Clarence was removing his coat and carefully placing it on the back of a chair in that rather irritating way that patients sometimes do at the start of consultations. He was clearly planning on staying a while.
‘I’m a little surprised you don’t recognise me’, Clarence replied, ‘but then you’ve probably only ever seen me in black and white. But surely you must remember George. His was a wonderful life.’
‘Well bully for George is all I can say. I hope he’s happy’
‘Indeed he is. Very happy. But from what I couldn’t help overhearing you saying just now, it would seem that you’re not feeling quite so positive yourself these days. Have you thought about chatting it over with your appraiser?’
‘And risk having a black mark made against my name? Not likely! I know they’re supposed to be supportive but I’d rather not share how I’m really feeling with an appraiser. Fortunately they’re not generally hard to fool. Like long haired sheep it’s easy to pull the wool over their eyes!’
‘Perhaps then I can help a little – I do have some experience in the area’.
‘How do you mean? You’re not going to suggest CBT or mindfulness are you? Only, if you are I’m not interested’.
‘Not as such. It’s just that…well it seems to me that you are questioning just how useful your life as a GP has been. You think you haven’t made a difference. But that’s not true. You’ve made a huge difference, in innumerable ways, often without you ever having realised it’.
Scrooge remained silent, though on this occasion it was not by way of employing a therapeutic tool. On the contrary, he was eager to hear what Clarence had to say but reluctant to appear in any way enthusiastic. The angel, sensing Scrooge’s predicament, continued.
‘Well let’s start with the obvious shall we? Take Mr Carton. Surely you remember him and how, after your telephone consultation with him regarding his low back pain, you agreed to review him face to face and were thus able to diagnose his abdominal aortic aneurysm. He’s alive this Christmas because of your actions that day. And then there was the kindness you showed to Mrs Gray as she died. That mattered too you know? Enormously’.
Scrooge grudgingly indicated his agreement. ‘But it’s no more than any GP would have done’.
‘Perhaps, but that’s not the point. The fact of the matter is that what you did made a difference. If only ‘The Ghost of General Practice Present’ were here we could take you and show you how happy so many people are right now because of what you have personally done over the years. I’d WhatsApp her but I know she’s very busy haunting a Covid vaccination centre this evening. It’s been a tough year for the members of BASIL too you know.’
‘BASIL?’, Scrooge interrupted, ‘I’ve heard of SAGE, but who the heck are BASIL?’
‘“Beings and Spirits in Limbo”’, Clarence replied. ‘Thank goodness for Zoom is all I can say, though it would help if ‘The Ghost of General Practice Past’ would learn how to unmute himself. And as for ‘The Ghost of General Practice Yet To Come’, the less said about him the better. He’s just so full of himself for his correctly predicting so much remote consulting and the wearing of face masks during face to face reviews.’
‘Enough of that though, back to what I was saying. In addition to those positive outcomes you know about, there are so many small actions that you have taken that have had similar wonderful consequences, many of which you know nothing about. Do you remember that time you were able to reassure a couple who were about to call an ambulance for their child as they were so worried about him having come out in a rash? Well, as a result of that ambulance not being called by them, a man who suffered a MI that evening was attended to promptly when he called 999 and so was stented within an hour of the onset of his chest pain. And then there’s Dr Cratchit of course.’
‘What about Bob?’
‘He really was desperate that Christmas a couple of years ago you know. He didn’t tell you the half of it at the time but he really was close to the edge back then. It was your support that pulled him through. And don’t forget that it was you who gave a job to the young lady that is now his wife, not to mention the mother of their child. You gave her a chance when many wouldn’t have, not with her previous poor employment record. If you hadn’t taken her on, she and Bob would never have met. Indirectly the happiness of that young family is down to you. And I could tell you a thousand similar stories of how you’ve influenced individual lives for good.’
‘Even so, that complaint I received today. It’s completely justified you know. I made a mistake. A big one. People are suffering because of the error I made’.
‘So you made a mistake. I agree that that is regrettable and hard to live with. But did you really ever imagine that you would go through your career as a doctor without ever making a mistake? Surely not even you are that stupid. Working as a doctor is a bit like pushing people out of the way of speeding trains. On occasions you’ll not be able to push someone out of harms way in time. And sometimes you might get hit yourself. But do try to remember all those you are able to help, all those who manage to avoid pain and distress because of what you do.’
As Clarence had been talking, Scrooge had been gazing at the ground but now he lifted his head and, addressing his companion, looked him in the eye.
‘But it’d be nice to be appreciated a little.’
‘Well of course it would. But the value of an action remains irrespective of any appreciation that might be shown for it. Pleasant though it undoubtedly is, is it really so important to be lauded for what you do? Happiness doesn’t come so much from being appreciated for ones acts of kindness, rather it comes from the happiness of performing the act of kindness itself. Besides if you really want to be appreciated, post an amusing video of a cat on Facebook. Only don’t expect that to satisfy you for very long.’
‘If Covid has taught us anything Ebenezer, surely it’s this. That it is possible to be content with less and that, rather than striving constantly to gain more in life, we would do well to be content and enjoy the gift of life we already have. Life is uncertain, it always has been. We are not the sole masters of our fate, nor that of those we love or those for whom we care. There is much that we do not know, much indeed that we cannot know. As such we need a little humility and acknowledge just how little we truly understand. We need to stop arrogantly pretending we invariably know best. Everyone makes mistakes sometimes. Even you GPs!’
Scrooge smiled and took a step towards Clarence who had got to his feet and was now putting his hat and coat back on. Scrooge hesitated as he once again became mindful of social distancing guidelines. Clarence though, didn’t seem too bothered as he too was taking a step forwards. The two men exchanged a firm handshake.
‘Thank you, Clarence’ said Scrooge. ‘It was good of you to come this evening’.
‘‘Not at all, Ebenezer, not at all. It was a pleasure. And thank you for all your hard work this year. You, and all your staff, are doing a grand job in difficult circumstances. Don’t think that it’s not appreciated. And trust me, it isn’t going unnoticed, not by those who count, not by those you’ve actually cared for. Now, you’ll forgive me if I don’t stand and applaud you, and I can’t give you a voucher entitling you to a free coffee or a discount bar of chocolate, so I’m afraid this will have to do!’
And with that, and before he could undertake a detailed risk assessment regarding the merits of such behaviour, Scrooge was experiencing something he’d never experienced before. He was being hugged by an angel.
‘Don’t worry about Covid-19, Dr Scrooge,’ said Clarance, laughing as he sensed Scrooge’s unease. ‘This duffel coat and trilby hat offer complete protection. Or at least as much as those flimsy plastic aprons you’ve all been wearing these past few months. And besides, what’s the worst that could happen. Only that you die and discover what has long been joyfully known by many, that there aren’t varying degrees of danger in the place where I come from.’
As they separated, Scrooge looked somewhat bemused by the strange comment of his unexpected visitor.
‘Haven’t you heard, Ebenezer?’, said Clarence, continuing to chuckle to himself. ‘There are no tiers in heaven!’
And with that a warm glow surrounded Ebenezer. As it did so a bright light filled the waiting room. In a moment it was gone, and so indeed was Clarence. Scrooge, finding himself alone once more, stood motionless for a few seconds, trying to collect his thought. Perhaps he’d need to rethink that letter of resignation.
He walked out of the waiting room and made his way to the back entrance. He switched off all the lights and set the alarm before finally leaving the building and locking the door behind him. As he walked to his car he felt a vibration in his pocket. Pulling out his phone he noticed that he’d received a text message. It was from Bob Cratchit.
‘Where are you? We’ve been waiting for you. I trust you’ve not forgotten you’re bubbling with us over the next few days. Get over here quick or you’ll miss all the fun of putting the little one to bed. Remember we’re expecting you to do the full Father Christmas routine for us. See you soon.’
As he gazed at its screen, the phone vibrated again and another message appeared.
‘And we’re a little short of mince pies. Do you know where you could lay a hand on a couple?’
Scrooge looked back at the surgery. ‘I rather think I do!’ he said to himself smiling. Perhaps, he thought, this might be a Merry Christmas after all.
To read the full story of ‘A Primary Care Christmas Carol’, click here
And for a further story relating Dr Scrooge’s experiences during the coronavirus pandemic you will find ‘A Tale of Two Patients’ here
Other medically related Christmas themed blogs:
To read ‘How the Grinch Stole General Practice’s Christmas’, click here
To read ‘Twas the night before Christmas’, click here
To read ‘A Merry, and Resilient, Christmas’, click here