Paul and Melissa

J’ai essayé d’expliquer ces choses qui dorment, sans doute, au fond de notre instinct et qu’il est bien difficile de reveiller complѐtement. 

Maeterlinck.

 

This will happen twenty years from now.

My name is David Walkerburn.  I’m an Edinburgh lawyer, a partner in the firm of Cardwell Walkerburn, Writers to the Signet, 48 Heriot Row, Of This City.  I was in the New Club, Princes Street, with my friend the distinguished emergency physician, Professor Sir Alastair Cameron-Strange.  We sat in companionable silence, reading the newspapers.

“Listen to this.”  I read aloud from The Scotsman.

Scots Aristocrat Arrested at Uluru.  Macabre Discovery in Hot Red Centre.  You listening, Alastair?”

“Mm?”

“Police in Australia’s Northern Territory are being tight-lipped about the gruesome find, in a wild camping site in the Valley of the Winds, between Ayers Rock and the Olgas, of the dead bodies of a man and a woman, as well as of a new-born baby, alive, but in a state of severe dehydration.  A man found wandering in the vicinity, in a state of delirium, has been arrested.  He and the baby have been transferred to hospital in Alice Springs.”

“Mm.”

“Funny how the Australian outback casts up these macabre tales.  British tourists found wandering amid the spinifex in a state of confusion.  Then a dead body, or two, turn up.  Often a dingo is involved.  Intriguing.”

“Mm.”

“Professor, you don’t sound intrigued.”  I read on.  “An unconfirmed report identifies the deceased woman as the Countess of Acharacle, and the arrested man as the Earl.”

The colour drained from the face of my physician friend.  For a man who has spent the bulk of his professional life dealing with humanity in extremis, he looked shaken.  He reached forward and snatched the newspaper from my hand.

“Acharacle you say.”

He scanned the brief article.  There was a photograph of a young couple, the Earl and Countess on their Moidart estate, in happier times.  Alastair handed the paper back.  He looked abstracted.  “Excuse me.”  He rose rather unsteadily and took himself off to the lavatory.  He was gone for a considerable length of time.  When he returned I could see he had regained control of himself.  I saw him stop the waiter and order a drink.  He signalled to me across the room and I pointed to my glass and nodded.  He came back and sat down.  I said, in a lawyerly way, “Am I to suppose that the Acharacles are known to you?  Patients perhaps?”

“If they were, I wouldn’t tell you.”

“What a tragedy.  She was only twenty.”

“Nineteen.”

The drinks came.  He hesitated, then: “Perhaps I could tell you about something that happened twenty years ago.”

Alastair doesn’t talk to me about his work very often.  I laid The Scotsman aside, sat back, and took a sip of Islay single malt.  “Continuez.

And this is what he said.

*

Throughout my hospital career I have occasionally taken time out and dabbled in General Practice, just to remind myself what real life looks like.  I particularly value the experience of the home visit.  In hospital, we don’t have the opportunity to enter people’s lives in this unique way.  Perhaps the home visit is the nearest a physician can get to understanding the dynamic of a patient’s life.  What is it that you seek?  What makes you tick?  We doctors flatter ourselves that we understand our patients, but you know, in our brief consultations we only ever get a snapshot, like a single frame in a roll of 35mm film.  The rest is mystery.

The strangest house call I ever undertook as a GP took place north of Loch Sunart, in a narrow strip of land halfway between Loch Shiel and the Ardnamurchan Peninsula.  I undertook a weekend locum for the harassed local practitioner, approaching the end of his career, his own shelf-life, and burn-out.  I’d driven up from Edinburgh on the Friday afternoon.  It was the sort of November day we call dreich.  There is an even more expressive word in Gaelic: gruamach.  Thick low cloud enshrouded Rannoch Moor, and when I entered the long defile through Glencoe the atmosphere of oppression was suffocating.  A heavy sense of deep foreboding stayed with me as I crossed the Great Glen by the Corran ferry, and I knew it would not leave me until I had escaped from the blighted north-west on the following Monday morning.  The Gàidhealtachd was one vast desolate moor of clearance and desertion, and I moved through it conscious of inescapable history, of vague whispers, subliminal allusions to the conscription of a language and the systematic persecution of a people, and a culture.  I negotiated the single track road through woodland between Strontian and Salen in a mood of complete dejection.

I met Dr McGregor, striding out of his surgery in a state of evident agitation, and in a tremendous hurry.  He only paused to thrust a Gladstone bag into my hands.  “You’re wanted at the House.”

“House?”

“Acharacle.  Himself.”

“I was hoping you could orientate me.  Perhaps a little background?”

“My haste forbids it.  Ask Morag.  Housekeeper.  Mine of information.”  As an afterthought, he literally threw some car keys at me.  “Take the Land Rover.  Heavy rains forecast.  Four wheel drive.  You’ll need it.”  I never saw McGregor again.

The House turned out to be a prehistoric keep, a Scots baronial folly, a massive crumbling pile frowning over Loch Shiel.  I accessed it by a treacherous mud track that penetrated an interminable forest.  By the time I reached my destination, darkness was falling.  Just short of the dark shadow of the ramparted castle, I noticed, on the grass verge, a small child in dungarees, perhaps eight years old, with a serious, philosophical face, leaning on a gate, calmly observing my progress.  Then I was nearly driven off the track by an agricultural vehicle careering down on me from the opposite direction.  I caught a glimpse of a wide-eyed driver staring maniacally straight ahead, hell bent on escape.  He was carrying livestock.  I could hear the forlorn bleating of lambs going to market.  I had the odd sense the child was mourning their departure.  I crossed a causeway over a moat and drew up under a wrought iron gate as massive as a portcullis.  I pressed a buzzer on the wall.

“Yes?”

“Dr Cameron-Strange.”

“Yes?”

How irritating.  I wasn’t expected.  I patiently explained I had come on behalf of Dr McGregor.  The gate opened inwards with an agonised wail.  I edged through.  There was a cobbled courtyard, and a mews.  A porter met me as I got out of the car.  “This way.”  He led me into a gloomy cloister, thence to a turret, and a narrow spiral staircase hewn out of the stone.  We emerged into a vaulted atrium dismally decorated in stags’ antlers, jaded, moth-eaten tapestries, and hideous art depicting gory hunting scenes.  There were threadbare rugs strewn around the floor.  Vacant suits of armour stood sentinel and stared impassively in my direction from each corner of the chamber.  There was an enormous grated fireplace in which logs were blazing, but failing to provide any heat.  Above the mantel, a hundred muskets in a circular array formed a giant Catherine-wheel.

Himself emerged from an armchair before the fire.  I recognised the disdain for personal grooming, the bucolic sloppiness of the aristocrat.  He sported a pair of stained, bright orange corduroy trousers, and a shapeless woolly jumper covered in holes.  I introduced myself.  The craggy, debauched grey face quivered.  He offered me a limp hand.  “Acharacle.”  Anybody who calls himself by the name of his lands must have a fine conceit.

“Where the devil’s McGregor?”

“Taking a short break.  I hope I can help.”

“Who sent for you?”  He addressed his retainer over my shoulder.  “Who phoned for the quack, Fergus?”

“I couldn’t say, sir.”

“Hm.”  Himself frowned, in a perplexed way.  I had already noticed that his facial expression was one of fixed puzzlement.  It crossed my mind that he was dementing.  “Probably my son.  Bed bound for months.  McGregor knows the case.  Fergus, would you be so kind…”

But it turned out that Acharacle-fils had recovered from whatever it was that had confined him to his chamber.  He wasn’t my patient either. Must be some misunderstanding.  I was loath to head all the way back to the surgery only to be recalled again.  Back in the dismal atrium, Acharacle was staring vacantly through a long, slender, tessellated, pointed window down to the garden below.  He muttered to himself.  “What the devil’s he doing?”  I glanced down.  I saw a youngish man, prematurely grey, balancing a small child on his shoulders.  It was the child I had just seen on the roadway.  The boy was craning to look through a first floor window.  It was a bizarre vignette.  I supposed a father was playing with his son.  But it didn’t look like play; it looked like abuse.  I asked who else was resident in this ghastly edifice, who else might conceivably be my patient.  Thus I assembled my dramatis personae.  I was helped by sight of the family photographs on the mantel under the Catherine-wheel of armaments.  I expected them to have absurd names like Torquil and Rufus, but in fact the names were perfectly commonplace.  Acharacle-fils was absent, invisible; I never even got a name.  His wife was Jennifer.  They had two sons, half-brothers I gathered, Gordon and Paul.  Gordon’s wife was Melissa, and he had a son from a previous marriage, Iain.  So.  Half a dozen.  But who was I supposed to be visiting?  This was fast turning into a sardonic parlour game.  Hunt the patient.  I glanced at the photos above the log fire, marrying up names to faces.  The images that stood out were of Paul, a handsome young man, and of Melissa, very young, and very beautiful.  I decided to conduct a ward round.

I started with Jennifer.  She occupied an apartment on the top floor.  I took the lift.  It was a parsimonious and suffocating oblong cubicle barely the size of a casket.  I have a horror of confined spaces.  I bit my lip while the elevator painstakingly clanked its way upwards then lurched to a halt.  I emerged into a lady’s drawing room and a lighter atmosphere.  Jenny was a querulous, redheaded lady of middle age who looked to me to be in the prime of a robust and healthy life.  She hadn’t sent for me.  “But, doctor, while you’re here…”  I walked right into that trap.  She turned out to be one of the worried well, and she had a list.  I patiently went through it with her, and ruled her out, while she in turn ruled out Acharacle’s great-grandson Iain, a dreamy child, happily occupying his own private world.  So it had to be one of the brothers, Paul and Gordon, or Gordon’s wife.  What was her name?  Melissa.

I learned a little about them.  Melissa was Australian, from Caloundra, Queensland.  She was a teenager, half Gordon’s age.  It was all terribly romantic, said Jenny.  Gordon had gone walkabout Down Under, and when he met Melissa she was a damsel in distress, a frightened young woman who had been traumatised by some deeply upsetting experience and abandoned, lost in the middle of nowhere.  To me it all sounded a bit like Picnic at Hanging Rock.  Gordon had rescued her from whatever plight she was in, and brought her home.  Jenny had worried that Acharacle, in his patriarchal role as a clan chieftain, might object to the liaison and its precipitate nature, but he turned out to be quite philosophical about it, even fatalistic.

Fancy a young woman from the Sunshine Coast landing up in this godforsaken hole!  Had she been seduced by the idea of coming to the Old Country and joining the aristocracy?  Could she have had any idea what she was letting herself in for?

I asked if Melissa was happy.

“Happy?”  Jenny looked at me quizzically.  I don’t think she understood the question.

What about Paul?  Full of life, early twenties, just graduated (St. Andrews, fine art), champing at the bit, dying to get out of here.  He had a friend in some far off place who’d got sick, and Paul wanted to go and see him, but Himself had persuaded him to stay on until Paul’s father got better.  That now being the case, Paul’s departure was imminent.

That left Gordon.  Hedge fund manager.  Late thirties.  Intense, highly strung, prone to loss of temper and fits of rage, and something of a control freak.  That must be it.  Surely Gordon had to be my patient.  I had seen him down in the garden, balancing Iain on his shoulders.  I decided to go and find him.  I excused myself and got back into that hellish lurching coffin.

All the time that I wandered about that House I was conscious of numerous housekeepers and servants passing silently along the corridors like spectral wraiths.  The third floor was deserted.  Reluctantly I got back into my lift.  It stopped at the second floor and the doors opened on to a marital spat.  Gordon had removed the coat of his executive pinstripe suit to reveal a garish pair of bright red braces.  He was pacing the floor, multi-tasking, simultaneously taking a call on his mobile while interrogating his child bride.   He briefly clamped the mobile between cheek and shoulder and deftly loosened his tie.

“Get back to me about the FTSE and the Dow…”

But I couldn’t stop staring at Melissa.  She was one of these girls who didn’t have to dress to impress.  She would have looked good in a sack.  Actually a sack was pretty much what she was wearing, a kind of shapeless kaftan in muslin.  I should have paid more attention to that, but I got distracted by these bewitching eyes.  If I were to tell you that Melissa was, and remains, the most beautiful woman I have ever set eyes on, you will tell me that I am prone to exaggeration.  Besides, any blond-haired, blue eyed teenager on the beach at Surfer’s Paradise is likely beautiful de rigueur.  They themselves, despite the armour of hauteur, are the only ones who don’t know it.  Youth is wasted on the young.  What was so special about Melissa?

Her hair.

“Buy at four fifty. Then if the price tops five fifty, sell.  Yah yah…

“Well where the hell did you drop it?”

“Blind man’s burn.”  Melissa’s voice was soft and low.  I could hardly detect an accent.

“Well you must go and find it.  Not you, Maggie.  I’m talking to Melissa.  Yah yah.”

“Now?”

“Yes, now, Melissa.”

“But it’s dark.”

“It’s a gold wedding ring, Melissa.  Twenty-four carat.  You have to find it.  Take Paul with you.  I don’t know what the hell you and Paul were thinking of.  You are children.  Sorry Maggie.  Where were we?”

I closed the elevator doors and continued my descent.  Gordon was very exercised about that twenty-four carat ring.  He reminded me of Othello, and his preoccupation with a handkerchief.  “The handkerchief!  ‘Zounds!  My mind misgives!” Gordon struck me as a jealous, and a very irascible man.  He was a corporate man.  He was the sort of man who had decided that he was surrounded by nobody but fools and idiots and as a result he was at the end of his tether.  Back in the lift, I must have pressed the wrong button because before I knew it I was descending into the crypt of the castle, and the bowels of the earth.  I travelled so far down that I experienced the sharp otalgia of barotrauma.  Down in the vaults, I came to a shuddering halt.  The door opened on to a narrow passageway carved out of the rock.  Ahead, there was the faintest glimmer of light.  I should have closed the doors and reascended immediately, but something compelled me to step forward toward that faint light.

It was surreal; maybe I just imagined it.  I found myself in a grotto, deep below the surface of the earth.  It must be some profound underground tributary feeding Loch Shiel.  Ahead, the water appeared still, dank, black, and fathomless.  I had discovered a subterranean ocean, from which emanated a stench of rotting decay.  I sensed that if I didn’t get out of this place immediately I would lose my wits.  I was conscious of an all-pervading, crushing sense of complete terror.  I stepped back from the hidden sea and its fetid miasma, turned, and literally ran back to the sanctuary of the lift, closed the doors, and got the hell out of there.

After that, things happened very quickly.  I made my way back to the atrium where I had first met Himself, to find that the marital spat, far from blowing over, had got completely out of hand.  They were positioned, as in a tableau, in front of the log fire, a tear-stained Melissa on her knees in an attitude of supplication.  Gordon stood over her.  He was incandescent with fury.

“Bitch!  Bitch!  Seeming, seeming, scheming, ungrateful, harridan!” 

It was when he started to drag her across the floor by her beautiful hair that I had to intervene.

“Stop that.”

He screamed at me.  “And who the hell might you be?”

“Never mind who I am.  I’m phoning the police.”

“How dare you!  Why don’t you stay out of other people’s business?  Leave this house immediately!”

I must admit I had the overwhelming desire to smack him on the jaw.  I think he must have sensed it because he stopped dragging his wife by her hair across the floor, and looked at me in surprise.  Maybe nobody had ever dared to cross him.  There was a pause and a brief interlude.  I remember I caught sight again of the photos on the mantel, and my gaze fell upon the image of the one person I’d not seen in the flesh – Paul.  Melissa followed my gaze and for a brief moment I captured her expression as her eyes settled on the same picture.  I might never have caught it.  It was my single frame in the roll of 35 mm film – that look of great and abiding tenderness.   Thus all was made clear to me.

Suddenly Melissa gave a strangled cry of pain.  She fell on to her left side, clutching her abdomen.  I saw the dark stain begin to spread across the muslin of her flowing dress.  Automatically, I knelt beside her and laid a hand on her tummy.  It was rock hard.  Gordon snapped impatiently, “What’s the matter?”

“She’s delivering.”

“What?”

“She’s having a baby.”

What?”

I reached into my pocket and handed Gordon the car keys.  “It’s a Land Rover.  It’s parked in the courtyard.  There’s a large crash box in the boot.  You can’t miss it.  Get it.  Quick.”

But there was no time.  I didn’t so much manage a birth, as preside ineffectually over its inexorable progress.  I don’t know how much time elapsed as I concentrated on the technical aspects of the obstetrics, but I became aware that various servants had filed silently into the room and I was being handed clean towels.  Nobody expressed the slightest surprise at this extraordinary turn of events.  It was almost as if it were preordained.  I stared at the new arrival, the pale, flat grey sliver of life.  I estimated twenty four weeks.  The cusp of viability.  Then to my enormous relief the skin pinked up and the baby emitted a pitiful bleat.  Gordon, wide-eyed with horror, returned with the crash box, and I was able to cut the cord and deliver the placenta.

Then it all went downhill.  She just wouldn’t stop bleeding.  I called out, to nobody in particuIar, “Get an ambulance.  Blue light.”  I was vaguely aware of Gordon tapping out a number on his mobile with a shaking hand.  I forced myself to think pathophysiologically.  Why’s she bleeding?  Not retained placenta.  Not retained products.  Uterine atony?  A soft tissue laceration?  Uterine rupture?  A coagulopathy?

With a sinking heart I noted the pallid skin with its clammy frost.  The pulse at the wrist was thready.  The arm was limp and unresisting.  She had withdrawn into herself like an injured animal retreating into its lair.  I took her blood pressure.  80 systolic.  Shock.

I cursed the environment I was in.  The light was terrible.  We hadn’t even been able to get Melissa off the floor.  At least one of the servants had dried off the baby and fashioned a makeshift crib near the log fire.  I got two drips up and poured fluids in, normal saline and then colloid.  But she needed blood above all else.  Thank God I found a vial of oxytocin in the crash box.  I gave her ten units.  It didn’t make the slightest difference.  Then I gave her ergometrine, 250mg intravenously, then 250 mg intramuscularly.  How I wished I was back in Edinburgh with a six minute ambulance response time.  Here, the ambulance would take forever.  And the rains had started.  The cavalry might not reach us at all.  I set up an oxytocin infusion.  What else could I do?  Rub up the fundus.  Examine the genital tract – as best you can – for tears.  Anything else verged into surgical management and I had neither the tools, nor the environment in which to proceed.  Uterine artery, or internal iliac artery ligation?  Hysterectomy as a last resort?  Impossible.  All I could do was tamponade the bleeding as best I could, with a mass of sterile packs, and wait.  Slowly I became aware that the entire household staff had entered the room and had formed a semicircle around its periphery, like the chorus in a Greek tragedy.

Now she was deathly pale.  I had a very bad feeling about the way things were going.  As a doctor, I had never before, nor since, felt so wretched nor so helpless.   When Melissa spoke, her voice was almost inaudible, as if she were speaking from another world.

“Where is Paul?”

“He is at Blind Man’s Burn.”

“Why doesn’t he come?”

Gordon said, “I need to speak to my wife, alone.”

“I don’t think so.”

“I promise I won’t harm her anymore.  Please, see, you can leave the door open.”

But I wasn’t going to leave my patient.  As a concession I retreated a few steps.

“Melissa.  I need to know.  Did you love Paul?”

“Of course I love Paul.”

“I mean, did you love him… with a forbidden love?”

As one, the Greek chorus fell to its knees.

She whispered, “How can love be forbidden?”  I believe it was the last thing she said.

Now the eternal wait for the ambulance no longer mattered.  It didn’t even matter that the blue light approaching through the dense forest belonged not to an ambulance, but to a police car.  I gave the two startled police officers a brief handover, and suggested that one of them might wish to take a turn down to Blind Man’s Burn.  Acharacle made another brief appearance, pausing to look absently at the girl’s inert body, and then at his great granddaughter.  He never lost his mystified look of profound puzzlement.  It was nineteen years ago.  But for me the memory, the sharpness of the image, has never faded.

“Poor little mite.  It’s your turn now.”

 

 

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