By Dickens

‘Another one to see you Doctor,’ said the receptionist, her droll tone on the phone, giving me adequate warning. ‘A Mr McDermid.’

Shuffled feet, sharp knock on the door moments later, and I knew what to expect. All my patients seemed to be elderly, with a number of different medical conditions relating to age, congregating like crows on telephone wires in the seats outside reception, and bustling into my office with a sharp sense of entitlement that something had to be done. They knew I would disappoint, but they wouldn’t leave without clutching something to their chest: a prescription, an appointment with a specialist, or a podiatrist – I favoured that one as we had a number of skilled practitioners upstairs in the green suite, book online, mostly female, and more skilled in listening to their endless flapping, whinging and whining. My least favoured option was another appointment, usually in a fortnight ‘to see how we’re getting on,’ I had the voice off pat, but as I was nearing retirement myself and only working part-time hours I tried to schedule for them to see someone else. Someone more suited. Someone more caring. Someone who gave a fuck.

I liked to think myself a realist and had no doubt that the way the NHS was going GPs like myself would soon be replaced with the cheaper option of a health care assistant, receiving the minimum wage. Software and algorithms would be faster and more efficient in determining patterns of patient illness and treatment would be automated. The future was already here and, although I felt sorry for those training to be a doctor, with the enormous debts that entailed, well, that was their problem, not mine.

But it didn’t take a robot to identify another clear pattern – the rise in mental illness, as we became a more Dickensian society the idea seemed contagious and take hold of a significant group of the population. I blamed television. Younger patients seemed to dress and behave as if they lived during that time period. Last week, for example, I had a Mr Micawber, fumbling for his fob, with a dose of the ‘collywobbles’, and questioning me on my annual expenditure, giving me a recipe for happiness and instructing me on how to prevent misery. At least he left by the door.

Bill Sykes grabbing me by my starched collar, out of the swivel chair left by a different route. ‘Come you vagabond, don’t try none of your nasty tricks with me’ he said, leering, beering bad breath into my face, holding me captive, ‘what have you done with my fuckin’ pit bull?’

Dotty, the head receptionist, heard my cries for help and stuck her head in the door. Bill flung the grey polyurethane seat through the office window and attempted to escape over the rooftops. He wasn’t successful, stepping onto the path outside our ground floor practice, but slicing his hand and dicing his leg on the glass. He was met by a police constable—more square than tall, that really needed to think about a proper five-a-day diet—and escorted in an ambulance to hospital to get his hand and leg attended to.  

Mr McDermid strode into my office and sat himself down, banging the floor with his cane. It was an impressive stick, smooth and slick, ebony coloured with the handle in the shape of a dragon. Probably plastic. But one could never tell. Although I can’t remember the exact words, The Guardian carried a front page report of how wards in our mental health units were filling to overflowing with Dickensian villains, breaking the rules with regard to the no-smoking ban, flouting Havana cigars, breaking curfews and absconding with each other to the nearest public house. They illustrated the story with a feature about a paramedic stabbed with sword stick. I’d laughed aloud when reading it, thinking what you can expect in London’s East End.

‘Marj!’ I shouted my wife through to read it. She’s a GP too. Pretty in an unpretty way.  A bit younger than myself. Did some intern work in Gartnavel in a grotty mental-health unit. Sharp red nails flicked through the report, she made a face and shrugged. ‘Anyone that lives down there with properties costing the moon, must be bonkers anyway.’ She let the newspaper fall back into my lap. ‘Probably a resident alien,’ was her diagnosis. ‘You shouldn’t worry about things so much,’ she said, squeezing my shoulder.

‘You can’t say that.’

‘What?’

‘About aliens.’

‘It’s a great British tradition to mock foreigners. Think ourselves more important than we are. Where do you think we got the terms wog and frog?’ She sashayed away to watch Eastenders in the living room

  I studied Mr McDermid’s file on the computer -his address was Dickens Avenue - and studied him even more closely over the top of the screen. He had the long coat, the glowing chain sticking out where he kept his fob, he had the ginger whiskers, the moustache that needed a comb through it, and a ruddy red complexion that spoke not of age, but youth and the unwashed stink of the gentlemanly ill.

‘No one is useless in this world who lightens the burdens of another,’ Mr McDermid remarked apropos.

‘Indeed,’ I remarked, hoping I’d spoken pleasantly enough. Thinking about the possibility of panic buttons being installed and beefy security guards standing beside me for every consultation. I took a deep breath and dived in, making eye contact. ‘And how can I help you Mr McDermid?’

His face reddened beneath all that facial hair. I bit down on my bottom lip a loop of Dicken’s running through my head, haunting me: It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief…

The patient’s chair creaked as he splayed open his legs and pulled down his zip. ‘I’ve got a wart,’ he said, looking down into his lap.

I grunted, trying not to laugh, never happier to hear such of such a thing. ‘Oh, no,’ I said. ‘We’ve got a clinic for that upstairs. Ask at the desk.’

‘You’re not going to look?’ he asked, temporarily discombobulated with his penis in his hand.

But it was his face I studied. He tugged at the handle of his stick revealing something far more unsavoury.

‘Those who live by the sword, die by the sword,’ I said, cowering away from him.

‘By gad, man,’ he said, ‘that’s not Dickens! And I don’t give a Dickens’.