Graham Swift - Learning to Swim - And Other Stories

M. came to my surgery the week following his first visit, and the week after that, and at intervals right through that winter. I was wrong in ever wavering on his first visit. I summed him up as a hypochondriac of the thorough-going kind. For one thing there was his persistence. For another, there was the seemingly infinite adaptability of his symptoms and the discrepancies in his description of them. For example, when, on one visit, I had dismissed some localized pain as purely fictional, he would return a second time to tell me that the pain had “travelled”—from chest to lower abdomen, from heart to kidneys — so that I was obliged to reconsider it. After a while this “pain” became something omnipresent and amorphous, obscurely pervading his system but ready to fix itself in those regions where he imagined, I suppose, I would be least able to disregard it. He would often describe in some detail the classic symptoms of certain complaints — the sort of thing anyone can read in medical encyclopaedias — but he would forget some tell-tale associative factor or he would fail to reproduce the physical signs. Then he would fall back on his old stand-by: “But Doctor, the pain’s quite real,” and I on mine: “For God’s sake — there’s nothing wrong with you.”

I could not be rid of him by merely rebutting his complaints. It occurred to me, of course, that there was another line to be taken. M.’s hypochondria itself, palpably neurotic, was the only thing about him which could be legitimately treated clinically. I should have questioned him about his mental history, his anxieties, perhaps referred him for psychiatric treatment. But I did not do this. It seemed to me that to take M.’s condition seriously would quite probably have the effect of indulging and encouraging it rather than removing it. I could not suppress the suspicion that he was carrying out some elaborate joke at the expense of medicine and I did not want to fall victim to it. Besides, I had no wish to extend an already excessive interest, on his part, in disease. There is nothing I despise more. Don’t mistake me. I did not become a doctor out of an interest in disease, but because I believe in health. The fact that half my family were medical men makes no difference to my motives. There are two ways of confronting disease: one is sound practical knowledge; the other is health. These are the two things I value most. And health, believe me, is not the absence of but the disregard for disease. I have no time for the mystique of suffering.

So I could give M. nothing more than the crude advice that a thousand would-be patients give themselves — very effectively: “Forget about it. It’s nothing. You’re fine.” And I said: “I don’t want to see you here again.”

But he did come again, and he was an infernal nuisance. There were times when I had to restrain myself from shouting at him at the top of my voice, from grasping hold of him and ejecting him bodily from my surgery. Sometimes a quite violent hatred for that despondent face, for his pleading manner rose inside me. I wanted to hit him. Then I would begin to treat him with a kind of casual indifference — the way a bartender treats a regular customer who comes in every night and drinks alone at the bar, cheerlessly but harmlessly. Then I would get angry again; angry at M., angry at my own acquiescence. “Look,” I said, “I have really ill people to attend to. Do you know what really ill people are? You are wasting my time and preventing me from helping people who really require help. Go away. Do something! Take up ski-ing or mountaineering — then perhaps you might find yourself in genuine need of a doctor!” But he would not be beaten: “I am really ill.”

Once when I had shown him out I noticed that my hands were shaking; I was quite distraught.

“Who is that man?” my wife said.

We were sitting, about to have lunch, in our dining room, which looks out across the front garden onto the road. On the opposite side of the road is a bus-stop where sometimes, after I have finished surgeries, my last visitors can still be seen waiting for their buses. My wife sees my patients come and go. She asks about them. Sometimes I think she is jealous of them.

M. was there, in his crumpled blue raincoat. My wife must have noticed him before.

“That’s M.” I said. “He’s a damn nuisance.” And then I added in a sudden defensive, possesive way — I don’t know why: “There’s nothing wrong with him! Nothing wrong with him at all!”—so that my wife looked back at me in a startled fashion.

This was a short while before Christmas. My wife’s pregnancy was now quite visible. I have helped countless women through their pregnancies. This has given me satisfaction. But this baby, inside my wife, was like a barrier between us.

I said to M. about a week later (we were back to headaches and miscellaneous complaints, the jumbled up symptoms of half a dozen nervous disorders): “You know just as well as I do that you’re perfectly fine, don’t you? Why do you do it?”

It was a raw, foggy day in November. On such a day my surgery can seem cosy, a place of sanctuary. I have a fine oak desk with a roll top, a dark green carpet, a gas fire that fizzes gently; pictures on the wall — still-lifes of flowers and fruit.

I had put my pen down on my desk and leant back in my chair. I was ready to talk frankly.

“I am not well, Doctor — I come to you.”

There was sometimes something foreign about M.’s voice, his accent, his choice of phrase, his looks.

I sighed and swivelled slowly in my revolving chair.

“Tell me about yourself. What do you do? You’re some sort of clerk aren’t you?”

“Life insurance.”

This amused me. I didn’t show it.

“But what about your evenings? Weekends?”

He said nothing. He looked uneasily at my desk. He was like a schoolboy who clams up when the master becomes friendly.

“Don’t you have friends? A girlfriend?”

No answer.

“Family?”

He shook his head.

His expression was empty and opaque. Without pressing him further I could see the whole picture: filing and entering figures all day; a bed-sit somewhere, evenings spent alone. At night he would lie awake listening to his heart-beat, the suction of his lungs, the gurgling of his alimentary canal.

I thought of myself when I was twenty. I had pored over textbooks in the Medical School library. I had played Rugby for Guy’s; dated a girl from the Dental School.

“Well—” I began.

“Doctor,” he interrupted as if impatient with my digression. He had this way, despite his reticence, of suddenly pulling you up. “You are going to tell me what’s wrong?”

“Well, I was about to say that if you lead a fuller—”

“No, I mean what’s wrong with me. ” He patted his chest. Sometimes he spoke as if I were withholding from him some awful truth. “Please tell me.”

“The same as usual — nothing,” I said crossly.

“You know that?”

“Yes.”

“How can you know?”

This was like a game of bluff in some interrogation.

“It’s my job, for goodness sake.”

He drew his face a little closer to mine. It had the same sheepish look it perpetually wore, but there was something insistent, arresting about it.

“Doctor, you have to relieve pain. Do you know what pain is?”

I should have blown up at an absurd comment like this, gently spoken though it was. But I didn’t. I noticed I was swivelling quite compulsively from side to side in my chair. I had taken up the fountain pen from the desk and was rolling it between my fingers.

“Look, all this is rather pointless, don’t you think? We don’t seem to be any help to each other. Shall we call an end to the game now? Don’t you think it’s gone far enough?”