Chapter 16
Gracie had prepared the tea and the orange juice, and Alice had re-read the NHS guidance on stroke rehabilitation in adults, and the chairs were set out in her consulting room in readiness, but still, Alice was apprehensive, even as she sat under the warm glow of the new floor lamp she’d bought with her birthday cheques.
‘Don’t worry,’ Gracie was saying. She evidently knew everything, even Alice’s secret reservations about hosting this clinic.
‘The patients you’re seeing have all been transferred to community care or early supported discharge from hospital and have been meeting with Dr Millen for months. They’re used to coming here now.’
‘Remind me why Dr Millen can’t continue with the stroke care group?’ Alice said, flicking through her session plan one last time before everyone arrived.
‘Handover has to begin somewhere,’ Gracie said, and because Alice didn’t want anyone to wheedle out of her that she had no intentions of staying here until she was in her seventies like Millen, she kept her eyes fixed on her notes.
‘So you know who everyone is today, aye?’ Gracie was saying, not even trying to hide her lack of confidence in Alice.
‘I’ve read all their notes.’
Gracie thought for all of a second before sighing and closing the door, swiftly coming to sit down in front of Alice. ‘It’s not for me to talk about patients, but…’
Alice couldn’t help but feel relieved. She fixed her attention on Gracie. ‘Spill.’
‘So, there’s Mr Forte. Clyde.’
Alice found him in her notes. ‘Uh-huh?’
‘He had a big seventieth birthday do at the hotel in the summer. Next day, bosh! A stroke.’
Alice read from her papers. He’d been left with dysphagia, impaired swallowing function, which made taking his medication difficult. He’d also struggled with post-stroke fatigue. ‘I know about him,’ Alice said.
‘Did you know his wife passed away in September?’
Alice lifted her eyes. ‘I didn’t.’
‘Rosie Forte. It was unexpected, and his recovery took a nosedive, as you’d expect. He must have dropped two stone since then and only really leaves his house to get his messages and to come here once a month.’
‘Oh.’
‘He likes custard creams best.’ Gracie bobbed her head towards the refreshments table and a plateful of his favourites.
‘Got it.’
‘It’s the wee things that matter.’
Alice nodded. She’d sat in on rehab clinics before but they’d been largely impersonal, and not a regular thing at all, so she hadn’t got to know any of the patients. ‘I suppose in Cairn Dhu you come to learn these things about the community?’
Gracie was in full delivery mode, so didn’t pause.
‘And then there’s Kellie Timmony.’ She was leaning forwards now.
‘Poor lassie got the fright of her life a year ago when a stroke struck her at thirty. She’s only a few months older than me; same class at the school.
She was working away in Kirkaldy at the time, and nobody at her office job wanted to believe somebody so young could possibly be having a stroke, so they delayed calling an ambulance. ’
‘Oh dear.’ Alice knew too well what that could mean.
A speedy response was imperative in preventing the spread of a stroke.
She’d read the woman’s notes. Kellie’s had been a hard road to recovery, going through months of treatment to help with her aphasia as well as intensive physio to improve her mobility.
She’d only recently stopped using her wrist splints and foot orthoses and was currently prescribed supervised circuits which the group would complete together today as part of Alice’s clinic.
‘The hurdles she’s facing now,’ said Gracie, ‘are mostly mental ones. Lost her confidence, as well as her job and her flat in Kirkaldy. She’s back at her mum and dad’s in Cairn Dhu.’
‘Got it,’ Alice said, with the familiar twinge of sympathy in her chest.
‘Who else have we got?’ Gracie was saying, standing now so she could see Alice’s patient list.
‘Don’t expect to see him today,’ she said, pointing a long blue acrylic nail at one of the names.
‘He’s one week into a fortnight’s holiday in Malaga, and I happen to know this one’s got a Baltic cruise lined up, so you won’t be seeing him for a while.
’ She ran her nail down the list. ‘And she’s got her sister from Arbroath visiting so she’ll be a no-show, and this one’s already installed in the members’ bar at the hotel watching the curling championship qualifiers. Saw him queuing up for opening time.’
‘Sorry?’
‘His brother’s a professional curler, and he never misses a match.’
‘Got it. So… only two patients today?’
‘Probably for the best that your first one’s not too crowded.’
There was a knock at the door.
‘Are you inviting them in, or no’?’ the secretary said.
‘Oh yes, of course.’ Alice bounded to her feet. ‘Come in!’
The door opened and a face appeared. Grizzled cheeks, shaven hair on top with straggly lengths at the back and with sad eyes. Gracie went to the door and held it open for the gaunt man.
‘Mr Forte?’ she asked. Somehow, from Gracie’s description, she’d expected a sweet old grandfatherly fellow, but this man was in ancient biker gear and a Harley-Davidson t-shirt that had seen better days. He smelled of cigarette smoke and his skin was sallow.
‘You’re not Dr Millen,’ he said.
‘No, I’m Alice,’ she said, offering him her hand which he didn’t take.
‘A nurse?’
‘GP.’
He didn’t look like he believed her.
‘I’ve only ever had Dr Millen. Is he here?’
Alice knew she had to get this handled swiftly. She’d experienced it on the wards; it went with the job as a young female medic, but in her own clinic it could be a bigger problem. ‘He’s handed the group on to me, but I assure you, I’ve read all your notes and…’
Mr Forte was scanning the room, looking for something, his eyes landing on the plate of custard creams. ‘Did you bring those?’ he interrupted.
‘Uh…’
Gracie, behind his back, was nodding vehemently.
‘Yes. Yes, I did. Your favourites, aren’t they?’ Alice said with a smile.
He made a disgruntled sound that said he’d be no pushover.
‘Have a seat, Mr Forte.’ Gracie hustled him into a chair, his teacup at the ready – a real teacup, not a Gracie special, Alice noticed.
As soon as he was sitting, she set it – along with the biscuits – on the low table before him.
‘Dr Hargreave’s come from a hospital in Manchester,’ Gracie was telling him. ‘Top of her class, too.’
Alice might have wondered if Gracie had peeped at her CV, if only for the fact that she absolutely hadn’t ever been top of any class. Gracie was just trying to help her gain his trust, which, given his mutterings and scowling, wouldn’t be easy.
Over his knuckles in faded ink Alice saw tattooed the name Rosie. He was in mourning for his wife and recovering from a stroke. She had to go gently.
‘You’re not going to make us kick that around, are you?’ he said, spotting the sponge ball on her desk.
‘I definitely am.’
He sighed and dunked a biscuit in his tea.
Next through the door was Kellie Timmony, in sharp contrast to Mr Forte, she appeared to be in good health, but appearances, Alice knew, meant nothing.
‘Come in,’ she said, aware of Gracie pouring an orange juice for the new arrival, before leaving Alice alone with a thumbs-up from the doorway.
‘Dr Millen’s not taking the group any more,’ Mr Forte said before Kellie had even taken her seat.
‘Oh! Right.’ Kellie brightened considerably.
‘Since it’s just going to be the three of us today,’ Alice said, which made Mr Forte glance to the door, probably still hoping for Millen to appear and say this had all been a prank, ‘Let’s get started.
I’ve got your exercise regimes here in my notes.
’ She reached for the ball, and Mr Forte rolled his eyes.
After a slow kick around the room while the three remained seated, a word-search exercise which Mr Forte found a good deal easier than Kellie, and a series of chin tucks and head manoeuvres, Alice had performed nearly all of the activities on her list and taken notes to send back to the stroke team at the hospital.
‘Before we make our circuits,’ Alice said, and Kellie audibly groaned at the prospect, ‘it says here we need to update our long-term goals. Goal setting is an important part of recovery, as you know.’
Mr Forte cut in. ‘Mine’s not changed. I want the sign off so I can get back on my motorbike.’
Alice nodded, writing this down.
‘And what do you want, Kellie?’ she asked, worrying immediately that she sounded patronising like a Santa’s grotto elf.
Kellie didn’t speak.
‘Go on, lass. Tell her what you told Dr Millen,’ encouraged Clyde Forte, who wasn’t grouchy with everyone, it seemed.
Kellie appeared unsure but she cleared her throat before speaking. ‘I just… I just want my spark back.’
Mr Forte nodded sadly at this, as though he’d given up hope of rediscovering his own.
‘I just want to feel like me again, but… will walking round the surgery carpark do that? Or kicking that bloody ball? Or…’ Kellie stopped, shamefaced. ‘Sorry, I just…’
‘I know,’ said Alice. ‘I know.’
Alice thought of their lives put on hold while they recovered, thought of the frustration and the pain, and the fear these two had been through, and there’d be their family’s shock and worry to deal with too, or – she wondered about Mr Forte – dealing with this by themselves.
Progress in stroke recovery, Alice had read, was often accompanied by setbacks, emotional and physical.
All of this seemed written as plain as day on Mr Forte’s face and in Kellie’s downcast eyes.
Alice spoke on. ‘Listen. I know I’ve just appeared in your lives as if from nowhere, but I do want to help, and I’m qualified to help you…’
‘You’re no Dr Millen,’ grunted Mr Forte.
‘Thank God,’ whispered Kellie.
‘I think I can help…’ Alice went on.
Mr Forte sniffed a sharp little laugh. ‘Dr Millen was helping. He’s been in our lives since Kellie was born, since my Rosie was in the surgery’s mother and baby group…’ A wash of emotion stoppered his voice and he, just like Kellie, looked on the verge of tears.
Alice, not knowing what to do, reached for the referral letters on her desk. ‘I do have something I can offer you, something new.’
Mr Forte fixed her with a look that said he already wasn’t interested. Kellie didn’t look up at all.
‘It’s a community gardening project, actually,’ she began, and even though she knew she was fighting a losing battle, she went on to sing the project’s praises to the people she at least hoped would be her first two recruits.