Out of Practice (16 page)

Holly could have sworn that Elsie winked at her lasciviously, but when she looked again she was sipping tea, one little finger outstretched, as if butter wouldn’t melt.

Holly tucked her hair back behind her ears and watched her patient. Dan had sent her here to assess Elsie for dementia and Alzheimer’s. Maybe it was Dan who was losing the plot, because
from where Holly was sitting, Elsie looked as sharp as a tack. She fumbled in her bag, completely unnerved, and took out her notebook, where she was supposed to write down all her observations
about Elsie to add to her evaluation file.

‘Ah!’ said Elsie, clearly disappointed. ‘I see we’ve moved on to the professional part of our visit. No matter. There’s plenty of time for us, Holly. I’m
always here when you need me.

‘But, you know, Holly, I’m sure Dr Carter does know what he’s talking about, but I really don’t think I
am
losing my marbles. Que sera, sera,’ she sighed.
‘Maybe there are benefits to this Alzheimer’s business anyway? You know, always meeting new people, hiding your own Easter eggs . . .’

For all her witty comments, Elsie seemed to have withdrawn into herself a little at the sight of the forms and Holly felt bad for cutting her off mid-flow. She couldn’t account for how
Elsie was making her feel. It was as though Elsie had 20:20 vision where Holly’s life was concerned and Holly didn’t feel quite strong enough to hear any more home truths this morning;
not after last night.

‘Let’s just get this bit done, Elsie, and then we can have another cup of tea.’

Holly ticked her way through the boxes, without a word. She could see without asking that Elsie was perfectly able to dress and feed herself, she could probably stand up for herself too, if
anyone gave her any of this Alzheimer’s nonsense. Holly noted again Dan’s scribbled note about her nocturnal wanderings and tried to rouse Elsie from her slump.

‘So, no more daffodils in the Market Place?’ Holly smiled at her, feeling awful for having brought the pall of reality down on her lovely morning tea party.

‘No,’ Elsie sighed. ‘Nobody really liked the daffodils.’ Her sad face made Holly feel even worse, until the flicker of mischief flashed briefly in Elsie’s beautiful
eyes. ‘I shall have to think of something a little more entertaining next time.’

Holly grinned. ‘Maybe we could have a little outing one morning?’

Elsie sipped her tea and looked wistful. ‘Now that would be nice. I only really go out for hospital appointments and funerals these days. Well, and the occasional dinner party of course,
but I suspect we could have fun together you and I. It would probably do you good to be led astray a little.’

Holly had accepted one last refill and then ducked away to use the loo before heading back to work. There was something about Elsie that she couldn’t put her finger on.
She was lively, she was fun and she was certainly insightful, but there was a sadness to her that Holly couldn’t place. She was already looking forward to getting to know Elsie better.
Another perk of local practice, she thought as she headed down the hallway to find the smallest room. Pushing open the door, Holly couldn’t help but laugh out loud. The smallest room in
Elsie’s house happened to be illuminated by a crystal chandelier and the loo roll holder appeared to be Elsie’s Oscar statuette. The irreverence of the gesture had Elsie written all
over it.

After washing her hands, still with a smile on her face, Holly had somehow managed to take a wrong turn out of the loo, though, because instead of arriving back with Elsie in the morning room,
she walked into a stunning kitchen extension instead.

The units were made from limed oak and the worktops from jet-black granite, but it wasn’t the fixtures and fittings that caught Holly’s attention. ‘Oh shit,’ she
muttered, as her gaze took in the chaos and the smile slipped from her lips. On every surface, there were cups, vases and jam jars filled with milk. Even an egg cup or two had been pressed into
service.

Elsie appeared at Holly’s elbow and rolled her eyes. ‘Such a bore, isn’t it?’

‘Hmm?’ said Holly succinctly.

‘Well, the milkman says that I’m to rinse the bottles and put them back out for him to collect. But I can’t possibly drink all that milk in one day, so I’ve had to
adapt.’

Holly watched her flitting around the kitchen, tidying the jars and bottles into rows. She felt suddenly wretched to find that Dan Carter might not be so wide of the mark after all.

‘I think you should probably keep the milk in the fridge, Elsie,’ she said gently. ‘And I’m sure the milkman wouldn’t mind if you only put the bottle out once
you’d finished.’

Elsie fluttered her fingers at Holly, ‘I can’t possibly keep it all in the fridge, silly girl.’ She swung open the door of the enormous refrigerator. ‘That’s where
I keep my make-up.’

Holly’s phone buzzed in her pocket and she knew it was Grace wondering where on earth she’d got to. There was probably a room full of patients waiting to be seen,
but Holly still felt awful about leaving Elsie alone. She’d helped her tidy away the milk and organise the fridge to leave a little space for food, but she wasn’t really sure what to do
next. Holly knew she should probably put in a full report to Dan, but she and Jason had been asked to do a week’s evaluation and it was only day two. Where was the harm in waiting? And at
least it was Dan she’d be reporting to, who was certainly the more human of the doctors when it came to making judgement calls. Holly sighed, rather wishing she’d just stayed and had
tea and left none the wiser. You certainly couldn’t help having a certain admiration for Elsie and she didn’t want to see her unhappy.

It was exactly this scenario that Henry Bruce had warned her about, wasn’t it? Becoming emotionally involved with one’s patients could only cloud objective judgement. Simply put, did
Holly like Elsie too much to write the report that needed to be written? She sighed, torn with indecision.

Elsie laid her head against Holly’s shoulder as they stood, putting the finishing touches to the new fridge layout. ‘I love my home. Don’t you? I think it sums up everything
I’ve ever been and everywhere I’ve ever gone. My life is here.’ She turned to cup Holly’s face with her hand, reaching to do so. ‘You do understand that, don’t
you, my darling girl? You understand what I’m asking of you?’

Holly logged into her computer and checked her afternoon schedule. It was all very well George insisting that The Practice offer Saturday clinics, but Holly couldn’t help
noticing that, even in the scant few weeks until his retirement, George wasn’t actually down to do any of them. Having said that, with just Dan, herself and one of the nurses working this
afternoon, the atmosphere in the building was noticeably calmer.

Even just the clip-clopping of Julia’s heels, or Henry’s none-too-discreet lifts, had the capacity to set Holly’s nerves a little on edge already. It was like the warning music
that started up in movies to put you on your guard.

She could hear the low murmur of Dan’s voice through the wall, his easy bedside manner something to aspire to. She took a sip of water, marshalling her thoughts away from Elsie Townsend,
and walked through to the waiting room.

‘Stevie Roberts,’ she said, immediately struck by the young boy’s appearance. He was scrawny and pale, looking much younger than his seven years. ‘Hi Stevie, Mr Roberts.
I’m Dr Graham, come on through with me and we can have a chat.’

She noticed that the boy was almost green and was carrying an empty Tupperware container just in case. Occasionally he would dab at his mouth with a bloody tissue. Settling him up on the
treatment bed, she could see that his little skinny legs were strangely mottled.

His eyes bugged out a little, which might suggest a thyroid problem, but for some reason Holly’s mind had immediately gone in another, more unlikely direction. She had half a mind to call
Dan in for a second opinion. She’d had a patient in Reading once, who’d lived solely on croissants and Nutella, who had then presented with similar symptoms. Or perhaps she was leaping
to conclusions and the poor lad had an absorption problem . . .

Was it possible that she’d gone from miniature cucumber sandwiches at Elsie’s, to a seven-year-old boy with scurvy in mere minutes?

Welcome to Middle England, she thought. She quietly checked all his vitals, murmuring reassuringly as she did so.

She’d noted the boy’s address when she opened up his file: the Pickwick Estate.

When people mentioned the Pickwick Estate in Larkford, they tended to do so with a certain grimace and a tilt of the head. The Pickwick Estate was Larkford’s dirty little secret, never
mentioned in any tourist guide, tucked away behind the small industrial estate that also housed the bus depot and the tile warehouse.

Out of sight and out of mind for most of the local residents, unless they happened to have their car broken into or their wallet snatched, when all eyes suddenly turned to the residents of
Dickens Drive. There was no dressing it up with fancy literary names – this was social housing at its most basic. And, since half the residents could probably only muster a reading age of
nine or ten, the fancy street names meant little more to them than the A36.

Holly knew from her interview that it was a source of continual aggravation to both Dan and George that there wasn’t more being done to help the residents there.

Lizzie actually had a theory that the council were actively trying to persuade the tenants to move elsewhere, for the land must surely be worth a fortune now for its development opportunities.
Instead, the four-storey sixties blocks crouched there in a grid pattern, with only the odd tree to break up the concreted expanse, where the residents’ children kicked a football around.
Hardly local planning’s finest hour.

Dan had asked Holly to support his plans to make the health education of Larkford’s children a priority. He wanted to restart the series of workshops he had run in the local school,
focusing on diet and exercise for the younger ones, and sex education and alcohol awareness for the seniors. The school had been amazingly supportive the first time round, but some of the parents
had complained and that was the end of that. Seeing this poor lad, made Holly think that the restart was long overdue.

She perched in front of the boy on a stool and gently palpated his calf muscles. Stevie pulled his leg away and began to cry quietly. ‘It ’urts when you do that,’ he whimpered
in his strong Somerset accent.

‘Talk to me about what you have for breakfast then, Stevie . . .’ Holly said as she softly counted the boy’s pulse rate under her breath.

Stevie immediately looked wary and glanced nervously over at his father, who was quietly sitting by the desk, fiddling with his mobile. Holly was astonished at the total lack of interest he was
exhibiting in his son’s medical exam. She was rather more accustomed to the helicopter mothers, who hovered around, endlessly peppering questions during an examination.

Since his father didn’t actually seem to be paying any attention at all, Stevie clearly felt a little bolder and spoke up, ‘My teacher at school said I ’ad to come in and see
you, coz my legs ’urt when I run and all the other boys are bigger than me. I get two pieces of toast at the Breakfast Club though – coz I’m little.’

‘Well, I’m really glad you did come in today, Stevie. Let’s see what we can do to make you feel a bit better, shall we?’ Holly reassured him. ‘And well done your
clever teacher for sorting it out. Now, after you’ve had some toast at the Breakfast Club at school, what do you have then, for the rest of the day?’

Stevie outlined his lunch of chips and beans, and the occasional egg in the school canteen, with the odd Mars bar thrown in for good measure. ‘That sounds a lot like my boys’
favourite lunch,’ said Holly gently, ‘but sometimes they like to have a really big glass of orange juice with it. Do you like orange juice, Stevie?’

Stevie shook his head again. ‘I like orange lollies though.’ He grinned widely and Holly tried not to show her shocked reaction at the state of poor Stevie’s gums. Bloody and
sore, there were gaps where his little milk teeth had fallen out early, since his rotten gums were too spongy to cope.

After they’d quickly established that supper at home consisted of a Nutella sandwich on white bread, Holly was quite convinced by her tentative diagnosis. She turned to Stevie’s
father. ‘Mr Roberts? We need to take a little blood from Stevie to send off to the lab. It won’t hurt,’ she reassured Stevie, noticing him stiffen, ‘but it will give us a
much better idea of how to treat him. The most important thing, Mr Roberts, is that we talk about Stevie’s diet and make sure that he’s getting enough vitamins and minerals to keep him
healthy.’

‘You try buying fancy food on what me and Cathy earn,’ he answered defensively.

‘Well, that’s something we can explore with the Health Visitor once the test results are back,’ Holly replied, wanting this lad’s father to take the situation
seriously.

‘Health Visitor? What’s that, some kind of social worker?’ ‘No, no. Just one of our team who will help Stevie, and you and Cathy, learn about economical ways to improve
his diet.’ Spotting immediately that Mr Roberts was none too enamoured with this plan of action, Holly changed tack. ‘Stevie is severely malnourished, Mr Roberts. He’s a very
poorly little boy.’

‘Just as well I brought him in then,’ said Mr Roberts. Barely into his twenties, the father looked just as peaky and underfed as his son, acne pitting his complexion.
‘Can’t you just give him some medicine? His prescriptions are free, aren’t they?’

Holly sighed. ‘Obviously we can give him some supplements of key vitamins to help him recover, but he needs a good diet every day to get him well.’ Holly’s eyes flickered to
the clock on the desk. ‘If you’d both like to come with me, we’ll see if Jade is available to do some of the tests now and have a chat with you about meal planning. Perhaps you
could call Stevie’s mum and she could come down and join you?’

Stevie shook his head. ‘Mummy’s asleep in the day.’