That was on the Saturday. The next day the family were all in the living room and I was in the kitchen, preparing lunch, when the telephone rang. Nick answered and then came into the kitchen. "It's for you Mum'. "Hello, this is Dr White speaking". "Oh Hello. This is Sister from the Infirmary. I'm afraid we have some bad news for you. Your Mother passed away 15 minutes ago". Pause. "Oh dear. Can you tell me what happened?" "Well, she suddenly became acutely breathless and died within ten minutes".

And so it had happened. Poor Mother's sufferings were at an end. For comfort, I told myself it was indeed the proverbial 'Blessed Relief', but all the same I could not help feeling cheated. I had tried so hard to look after her so that she could die at home, surrounded by those she loved and who loved her, but instead she died alone in hospital, perhaps not really believing it was only on a temporary basis. Perhaps she felt abandoned. We shall never know.

                          * * * * *
 

Mother therefore never saw the house that was so carefully chosen to suit her needs but, despite a sad beginning, we all settled happily into our new home. Ernie was still working enthusiastically for Chubbs and living in his caravan. We managed to see each other nearly every day and he would spend the weekends with us. I would put up the folding camp bed in the living room and sleep there, while he slept in mine. I think his sixteen stone and 6ft 2" frame would have been a bit too much for the little bed! We often had another visitor in those days - an attractive, lively girl called Lesley, to whom Nicolas was unofficially engaged. She would sleep in a sleeping-bag on the floor. There were times when I thought we would run out of floor space, never mind beds! All the same it was a happy and harmonious household despite the overcrowding.

The day came when Nick and Lesley approached me and said they wanted to get married. That was in the late spring of 1974. They were both so young; Nick was nineteen, Lesley seventeen. I was not overly enthusiastic but, as they were quite determined, I went along with their plans. Lesley's parents, who lived in Crieff, took over the responsibility for the wedding but a great air of excitement filled the house, with Nick talking fifteen to the dozen and plans getting discussed and changed, and alternative plans getting discussed and changed again. They were like a pair of children arranging a wonderful party.

The great day eventually came. A great day with all the trimmings. Lesley was dressed in white and Nick and the best man, odd Oddie, in grey morning-suits. Young Susie, aged 2«, was a flower girl and everything went off beautifully. After the official wedding was over all the young people congregated at Anne's house (she and John had now moved to a lovely house in Comrie), where the party continued. Young Susie had decided to do a striptease and all the young men took it in turns to throw her into the air to see how high they could reach. She loved it and was most reluctant to put on her nightie and go to bed.

The next morning Susie was up early, as bright as a button, but I cannot say the same for the other wedding guests! There were more than a few sore heads in the morning, and so ended the first of several weddings that were to take place from Barnton within the next two years.

The next wedding, in fact, was only a few months later. Dawn was to marry Jim Gilmour. a fellow member of the Divine Light. They wished to have a religious ceremony but, as they were not members of any established church, this posed a problem. After much deliberation the Minister of Cramond Church agreed to marry them in Jim's parents' house, which was roomier than ours. The girls, that is Vivienne and Dawn, were to make their own dresses and I was to bake the wedding cake, but how? Dawn was on a strict macrobiotic diet and not allowed eggs. After much thought I decided to boil up the fruit beforehand and add plenty of booze. It turned out beautifully moist and, if I say so myself, absolutely delicious. The decoration was not bad either.

Dawn's family and friends congregated in our house and then we all set off for the Gilmour's where the ceremony was to be held. The girls looked lovely in their simple dresses with garlands of flowers draped round their necks. In the evening Ernie and I joined the young ones at the Ashram where a quiet celebration was held. We sang songs and ate the food which the Premmies had prepared. It was an unusual but, in its own way, impressive wedding feast.

Our overcrowded household was slowly diminishing. First Nicky left to live in Musselburgh with his wife Lesley. Then Dawn left to live with her husband Jim. Neither were far away and we continued to see them frequently, especially Nick and Lesley who loved to come up on Sundays for a good lunch and conversation.

Ernie was still working hard for Chubb and living in the caravan, coming to stay most weekends, but going back to the caravan on Sunday evenings. It must have been around this time, when we were all sitting talking after Sunday lunch, that Viv or Nick - or probably both - said: "For Goodness sake Ernie, why don't you just move in with Mother? It's ridiculous for you to stay out there on your own when we know you are dying to be with Mum and she is longing to have you. Do come".

And that is how it happened. Not only with the family's blessing, but almost at their command. From then on we lived as man and wife, although it was not until 1979 that we were actually able to make it legal. All the same, if devotion has anything to do with it, we were more married than many conventional married couples I know. So much so that I can never remember the date of our actual marriage. Although it was a lovely day and I enjoyed every moment of it, it still seems of lesser importance than the day he moved into Barntongate or, indeed, the day he came to the first party at Morningside and sat on the needle.

Dear Ernie! He tried so hard to keep up his moral standards and set a good example of behaviour to the young ones; but in the end it was they who would decide when it was time to stop this nonsense and pretence, to come out into the open and live together in love and devotion. And he did set a good example - in how to love and cherish, in how to consider you partner's feelings before your own, in patience and tolerance, especially of my long working hours which did not lessen as the years went by. Indeed the work load seemed to become greater as time went on. Perhaps it was the increased time needed for administration and the increased expectations of the patients. Or being happier at home, perhaps I grudged the time away from the house more, but I hope the latter feelings did not influence my attitude to the patients and their numerous problems.

The next wedding was Viv's. This took place in March 1976. After Dawn's wedding she had felt a little restless, if not actually lonely. She spent a lot of time travelling across Europe, taking casual work to finance her journeys, and gradually lost interest in the Divine Light movement. Sometime in 1975 she came back to Edinburgh, took a secretarial course, got a steady job and moved into a furnished flat which she shared with a number of other young people, including a tall fair young man called Alan Urquhart. It was not long before she came home one day to show us the ring on her finger which Alan had given her. She and Alan wanted to get married without a prolonged engagement and so preparations were soon underway. Never was a wedding so easily organised at least from the mother's point of view . I left it almost entirely in Viv's capable hands, except for the finance of course, but as they decided they wanted a small, if not quiet wedding, that was not excessive. Both the bride and groom were part of large extended families so we decided to ask only the immediate relations and a few personal friends.

Preparations were soon underway: the cake ordered, dress bought and Alan even persuaded to have his hair cut - but it was still below his shoulders. As Alan was a firm unbeliever they were married in a registrar's office and then we went on to a small private hotel where the wedding lunch was prepared. It was a great success - and everyone mixed well and enjoyed themselves, including Alan's two old grannies who, after a friendship of about 50 years, still called each other Mrs Urquhart and Mrs Hewett.

After the official do was over most of the guests came back to our house at Barnton where Nicky and I set to preparing some food to fill our hungry guests. Luckily I always keep a well-stocked larder and fridge and so in no time we had rustled up quite a feast. The party was in full swing when who should walk in, but Viv and Alan! Although a good deal of alcoholic beverage was consumed everyone remained happy and elated and no one behaved badly, except young Peter, Anne's stepson, who had been helping himself to booze unbeknownst to the adults and ended up violently sick and had to be put to bed. Ernie was at his ebullient best, and it was only recently that I heard that he had taken Alan aside at the wedding and had said in true fatherly fashion: "If I ever hear you've hurt this girl in any way, I'll come over and break every bone in your body". He wouldn't, of course, being a very non-violent person but all the same, Alan hasn't felt like risking it. In the next breath he paid for their hotel room for the night. As you can guess Alan and Viv got married on the proverbial shoe string.

A number of guests, including Ernie's two boys Ian and Keith, stayed the night, and the next morning after a late, very late breakfast we were sitting around talking, still in a festive mood, when who should walk in - yes you've guessed it - Viv and Alan! "Are we never going to get rid of you two?" was the general, but good-natured, cry from assembly.

                           * * * * *
 

In 1972 Anne and John had moved up to the lovely village of Comrie, in Perthsire, when Susie was about 6 months old. John came from there originally and being a madly keen fisherman was anxious to return as there were three trout rivers in the vicinity. Ernie was also fond of fishing so we spent many a pleasurable weekend walking by the river, if not actually fishing. Ernie would be quite happy just enjoying the fresh air and beautiful scenery and sometimes laughing at the frantic efforts of the other fishermen. He wrote some poems while visiting Comrie and out on the river, and his visits there enhanced his deep love of the Scottish countryside. We both enjoyed these visits, which were sometimes on our own and sometimes with other members of the family.

Comrie is a wonderful place to bring in the New Year as there is the famous parade of the Flambeaux, where several young men of the village parade down the main street and round the village carrying long poles of flaming pitch. They are usually fairly inebriated and don't notice the burns on their shoulders until the next day, when they queue up at the Doctor's to have their burns dressed. Apart from the Flambeaux, there is a fancy dress parade, in which the competitors follow on behind the young men with their flaming torches. The cottages have their upstairs windows open and people comment and laugh at the procession passing by below. There is also usually a bonfire and fireworks display followed by dancing in the square outside the Royal Hotel.

One New Year's visit to Comrie was far from happy although it started off extremely well. Mrs McHale had agreed to stay with Mother, and so Ernie and I, and Nick and Viv went to Comrie to spend the New Year with Anne and John. The weather was kind and we all thoroughly enjoyed ourselves and, after the formal festivities, the 'Oldies' ie. John, Ern, Anne and I went back to the house, leaving Nick and Viv to go first-footing.

An hour or two later they arrived back more than a little the worse for wear, but very happy. They had decided to round off the evening by paddling in the Earn, during which escapade Viv had lost her specs, without which she can see very little. They went off upstairs to bed, to the room which they were sharing with me. Five minutes later we heard a cry for help and there was Vivienne staggering from the bathroom after being very sick. I put her back to bed and a few minutes later she started to vomit again, crying, "I want Nicky". "I'm coming Viv", said he, staggering across the room in his underpants, a sweet but anxious smile on his face. "Go back to bed Nick. I'll cope", I said.

A few minutes later again Vivienne lifted her head off the pillow and cried plaintively, "I want Nicky". And again Nick got out of bed and toddled over to Viv. "Back to bed Nick", I said, "I'm coping. She will be alright".

John had come upstairs to help and was there to empty the basin when Vivienne vomited. And again Viv cried "I want Nicky", and again he toddled over. The fourth time this happened a slight note of irritation crept into my voice as I said. "Oh Nick! Do stay in bed. There is nothing you can do". He was starting to rise from the bed yet again, at which point, John seemed to explode. He rushed over, pushed Nick down, knelt on the bed, straddling him, and punched him hard on the face. It was terrifying and quite uncalled for.

Nick lay still for a minute and then, sitting up slowly, said in a dignified manner: "I'm not going to hit an old man". Then drawing himself up to his full height - all of 5ft 7 inches - he said, "If I'm not wanted here I'm going to leave straightaway". At which he hastily but methodically put on his trousers, shirt and jacket, and went out into the dark night.

Ernie and Anne had been downstairs all this time and had not realised what was going on. As soon as Ernie heard that Nick had left, he said, "I'll go and find him and drive him back to Lasswade, and then come back for you".

So off he went to look for Nick who had no means of transport and only a thin jacket for protection from the rain (which was by now pelting down). John was sullen and withdrawn and went off to bed. Luckily Viv soon settled down and fell fast asleep, oblivious to the trouble she had caused. Anne and I sat disconsolately in front of the fire for an hour or two before trying to snatch a little sleep.

It must have been around ten o'clock in the morning when Ernie arrived back at the house, tired but quite cheerful. He had driven around for over an hour before he found Nicky on the Crieff to Edinburgh Road, trying to hitch a lift home. He was drenched and delighted to see Ernie, but unwilling to talk of the incident with John. Ernie had driven Nick home to Lasswade, had a cup of tea and a couple of hours' nap in a chair, and then got into the car and driven back to Comrie. He was completely puzzled by the whole affair. He assumed there had been a fight over something or other and it was only later, when we had some privacy, that I was able to explain the true state of affairs.

John remained sulky but we stayed on for Anne's sake. She had prepared a delicious meal, which nobody was in the mood to enjoy, and we left with relief on the morning of 2nd January.

It was a disastrous end to what had started as a joyous celebration. One good thing came of it though. Vivienne never again over indulged in alcohol - or anything else for that matter - but Nick and John never really made it up. They remained distantly polite whenever they did meet - which was not often.

                           * * * * *
 

After Dawn's wedding came Christmas 1974 which, was a truly celebratory affair. The second Christmas in our new house but, as the first had been marred by the death of my Mother two weeks earlier, this time we were able to give our full enthusiasm to making it "a good Christmas". Each year for at least fifteen years before her death my Mother had said "This might be my last Christmas, so let's make it a good one", and with a few notable exceptions, they were. This year was not one of the exceptions and preparation went full-steam ahead. Ernie took on the responsibilities of wrapping the parcels and polishing the silver - a job he did to perfection, but which would take him two days to complete. Vivienne and Douglas helped with the decorations and I did the shopping and cooking - helped by Viv on Christmas Eve. It was a mad rush getting everything ready on time and working on Christmas Eve.

For lunch on the Day there was Viv and Douglas, Nicky and Lesley, Anne, John, Peter and Susie, Ernie and myself, and in the evening we were joined by Dawn and Jim Gilmour and my old friends Jimmy and Jessie Thomson. It was quite a party - we played silly games and Ernie managed to persuade everyone to sing carols to the accompaniment of tambourines, Jew's harps and Gajoos. The amount of food consumed was phenomenal and Ernie's punch helped to make things go with a swing. It certainly was not a quiet Christmas, but one well worth remembering.

We had only just time to recover from the Festive Season when Nicolas Mark II made his appearance on 13 January 1975. You have never seen a more excited expectant father than Nick. Vivienne had only just arrived at their flat in Musselburgh to keep Lesley company, when Lesley started in labour. This was about 11 pm on 12 January. Nick immediately got into a panic and phoned me.

"What will I do? What will I do?" "Keep calm, for one thing", I said and then, "phone a taxi and take her up to the Simpson's. There will be plenty of time. Now don't worry, but keep me posted."

Vivienne, like the sensible girl she is, went off to bed and slept like a log and - to tell the truth - so did I, but Nick went with Lesley to keep her company through her labour. It proved to be quite difficult and in the morning Nick phoned me up several times, but eventually said, "Please come up and perhaps the Doctors will tell you what is happening."

So as soon as surgery was finished, up I went to the Simpson's Maternity Pavilion, to be met by a very tired and harrassed-looking Nick. The doctors had already explained matters to him in the interval. I can't remember the exact details, but Lesley had been in the 2nd stage of labour for 2 hours or more and the baby's head had not descended, so they were going to do a fairly high forceps delivery. "Would Nicky like to wait in the waiting room?" "No", he said, "I want to see the baby delivered". "You might not like it. It will be a bit messy with blood etc. and we don't want you fainting or anything". "No", said he, "I'll be OK. I want to see everything".

So in he went to the delivery room and I went into the waiting room. I had to keep phoning the surgery to see there were no urgent calls, although I knew they could get hold of me if some really urgent call came in. Suddenly a beaming Nick burst into the little room. "It's a boy - a beautiful boy".

He had darkish hair with a fair streak at his right temple. "My", said an Irish nurse as she washed him and saw the fair streak in his hair "he has been blessed by an angel". Who knows perhaps he has.

That spring young Nick became famous for another reason besides his white streak. It was a beautiful spring day, the sun was streaming through the windows and the patio door was wide open. Poor Ernie was confined to bed with the first of his severe attacks of back pain but the door to the bedroom (which opened directly from the living room) was open and he was able to carry on a conversation with those in the living room. As it was a Sunday, Nick and Lesley were visiting us for lunch and, of course, had the baby with them. Ernie was lying in bed enjoying his gin and tonic and Lesley, after feeding the baby, brought him through to Ern, laying him on his chest and tummy. A minute or two later we heard a mighty roar of laughter from Ernie and, rushing through to the bedroom, were just in time to see the end of a perfect arc of urine landing in the glass of gin and tonic. A precise aim indeed!
 

                           * * * * *

                           CHAPTER 16
 

Perhaps this might be a good time to leave the family saga for a while in the comparatively peaceful time of the Seventies and go back to the practice which was becoming far from peaceful. This was due to the increasing number of cases of drug abuse which I was seeing - some seeking a soft touch to obtain supplies, a few genuinely seeking help in controlling their abuse and eventually 'coming off' and more sadly, to me at any rate, young men or women I had known even before they were born falling into the drugs trap. This probably happened more in the early Eighties than the Seventies.

I became quite adept at sniffing out the first category. Unless the patient or patients (they frequently came in two's or even three's), were obviously under the influence of some noxious drug, I liked to see them and hear their story. I felt it only right to give them the benefit of the doubt. It was interesting to hear their histories - whether genuine or otherwise - and it was amazing how often the tales they told followed a similar pattern. If it sounded too familiar I would say: "Oh , come off it Jimmy. I've heard all this before. Do you really expect me to believe your story?"

Sometimes they would laugh and admit to the falsehoods; sometimes they would add further embellishments; very occasionally they would get angry; and equally occasionally I would believe them. Whatever the outcome we developed some sort of rapport and indeed in some cases genuine affection. If I felt they had no intention of modifying their life styles and were only looking for an easy supply of their favourite drug they were shown the door and asked not to return. As a precaution we kept a record of these characters with a brief description and what they were after. We called this our 'Rogues' Gallery' and very useful it proved to be. If in future months or years someone arrived at reception looking vaguely familiar and not a registered patient we would look through our Rogues' Gallery and as often as not find their description  under either their own names or a false one.

Of course it was not infallible, especially in the earlier years, and it was rather demoralizing to find that someone for whom you had been prescribing on a regular basis - say for 6 months - and whom you had come to regard as a sort of friend had been attending another doctor for the same period and getting further supplies there. I am glad to say this did not happen very often but, I suppose, once is too often. I would put it down to experience and try to be even more careful in future. I was very meticulous about only prescribing small quantities at one time - usually one week's supply and in many cases I would insist that they pick up their supply from the chemist on a daily basis. This made for a lot of work for everyone - my receptionist, myself and the chemist but it was well worth it, especially for the patient as it at least brought a little order and self discipline into their chaotic lives.

Seeing and talking to the patient on a regular basis was also one of my policies on which I insisted. Again this was extremely time consuming but well worth it and, I am sure, absolutely necessary if there is any hope of the patient cutting down or even, dare I say it, 'coming off'. I certainly learned a lot from these interviews - not least that drug addicts are as individual as any other group of people and should not be lumped together as 'Drug Addicts'. And that prompts the question of prescribing policies, from clinics or large group practices. I know there must be guidelines but these should not be too rigid - one method of treatment or management might suit one patient but be quite unsuitable for another. I liken it to education. I don't think there is one perfect system of education. I have observed that one school can be highly suitable and successful for one type of child but disastrous for another.

From a more practical point of view as well I found these talks helpful. As the patient came to know me better and talk more freely, I came to learn things through the grapevine: for instance if a patient was selling some of their supply; what was the latest trend; and, especially useful, if there was a stranger in the waiting room who might be on the scrounge or already getting a supply elsewhere.

One other thing I learned from talking and listening to this assortment of people was that drug addiction is very little different from other forms of addiction such as alcohol and tobacco. The main difference is that drug addiction is illegal and alcohol abuse is not. Alcohol causes as much family break down, ill-health, violence and death as drug addiction on its own. I stress this last point. The few early patients I saw who abused opiates tended to be gentle, intelligent, into 'Flower Power' and all the rest of the Hippy Movement, and were proud to tell you they did not drink, but in the Eighties the type of patient gradually changed. They came from a poorer background, were less intelligent, often unemployed and, unfortunately, often abused alcohol as well. That drugs and alcohol do not mix and are not conducive to a happy, healthy life style seems self-evident but trying to convince the abuser that this is so is a heart-breaking process and tries one's patience to the limit. One must not expect too much too soon. Many a day I have felt like shaking a young man hard when he has done something particularly stupid and got himself into unnecessary trouble. Unfortunately, doctors are not permitted to inflict physical punishment so I would give him, or sometimes her, a good ticking off instead, even raising my voice! I would feel better at the end of it but I don't suppose it did the patient any particular good.

The benefits to the patient of a regular interview with the doctor are also great. They often seem to live from one crisis to another and to be able to tell their problems, even briefly, to someone they know they can trust and who they feel likes them despite their faults and difficulties is very beneficial. It gives their ego a great boost if they can truthfully think: "The Doctor is my friend". It amazes me even now how genuinely fond I felt of some of the most troublesome patients. As improvement in controlling their habit occurred I felt that in a few cases at least they genuinely did not want to 'let the Doctor down', and they would be upset for my sake as well as their own if they had taken more than the prescribed dose or taken some illegal drugs.

Depending on the patients' commitment and to a lesser extent their intelligence I would try and involve them in the decision-making as to dosage, rate of cut-down etc. The fact that you ask their opinion and listen to their answer helps their self-esteem and emphasizes the fact that only one person is responsible for their abuse of drugs and that is themselves. Other people, including the medic, can only advise, help and support. They themselves are responsible for their own actions and only they can 'come-off'.

I will admit there were some patients to whom I did not apply this method - usually patients I did not know very well and of whom I was extremely doubtful. To them I would say: "We will do it this way. You will collect your prescription daily from the chemist and I will reduce your dosage at such and such a rate. This is the only way I'm willing to help you. If you don't like it then I'm afraid you will have to go elsewhere".

More often than not they would go elsewhere but a few would cooperate. I did not find this method very successful but occasionally it would succeed and this was always with a patient who had 'come off' previously and had a recent relapse. They had sought help before their habit had become too well established and were well motivated to finish with their drug habit.

I did not prescribe for all my addict patients. If they were unwilling to abide by my prescribing rules and were obviously using illegal drugs I might allow them to stay on my list as long as they didn't ask for drugs and if they behaved themselves generally. I tried to give them all a few guidelines in general behaviour which, apart from sticking to the prescribed dose of medication, included - 1) not asking to see a deputy doctor if I was not there. 2) not bringing a friend with them into the surgery - preferably not
   even to wait outside. This was particularly hard to enforce. 3) not making a nuisance of themselves in the waiting room. It was
   amazing how they liked to talk about themselves and their
   problems in a loud voice while waiting. 4) always being polite, especially to my staff.

This last was surprisingly easy to enforce, with a very few notable exceptions, because they knew they would incur my wrath if I heard them being rude or cheeky to Mrs Scott or Mrs McCann.

I hope I have not made it sound as if the management of drug abuse was easy because, believe me, it was not. It was not easy and it was only seldom rewarding. It was hard going, a constant struggle, and full of disappointments. The only defence was not to have too great expectations but, at the same time, not conveying to the patient that one did not have too much faith in his ability to 'come off'. You had to be constantly on your guard because the patients were up to all the tricks and as I said to the receptionist Mrs McCann, "You need eyes at the back of your head". If I was tired at the end of a long day, I found I had to be especially on the alert as then the temptation just to comply with their wishes so that I could get finished at a reasonable hour was so great. Many of them were bad time-keepers and had the habit of arriving just as surgery was finishing or even finished.They would come dashing in full of apologies and some improbable story which they were only too willing to tell me at great length while all I wanted was to say Good-bye and get on with my rounds.

Many doctors give fear of violence as one of the reasons for not taking drug addicts on their list but I did not find it a great problem. I always had the number of the local police station in front of me on the desk and if there was the slightest hint of trouble I dialled the number and, when the patient saw I was standing no nonsense, they would go away before the police arrived (which they always did in a very short time). I did not have to do this very often because the word soon got around that if I said I was going to call the police, I did just that.

I remember one guy who refused to leave even after I had called the police. He was not on my list and I explained to him that I was not taking on any more addicts because I already had more than I could cope with - it was nothing personal towards him - I just was not taking any more on. He would not take no for an answer and was beginning to get slightly aggressive in his manner, so I said: "I'll give you two minutes. If you are not out of here by then I'll call the police". He took not one darn bit of notice but just sat there and refused to budge, so when the two minutes were up I dialled the number. He still refused to move and became more aggressive, saying "I've got a knife. If you don't give me something I'll draw it". "You do that and you will be up on a serious charge. Don't be such a bloody idiot. And you are certainly going about it the wrong way if you want me to take you on my list".

I was not scared, just extremely impatient, as there were by now a great many people in the waiting-room. This time, as fate would have it, the police were longer than usual in coming but even when two large policemen arrived in the surgery he still refused to budge, so one took his left arm and the other his right and they lifted him bodily out of the chair and down the stairs to the van waiting in the street. As he went, he started shouting "I'll get your family, I'll burn down your house".

"Don't worry Doctor", said one of the Bobbys with a smile, "he always says that. You're quite safe". That was about 3 years ago and my house is still standing, so I think the policeman was right.

                          * * * * *
 

Many years ago, when I had only recently taken the first addict into my practice, an incident occurred which might have been very upsetting but which I found only amusing as the threats were so ridiculous. It was during an evening's surgery and as usual there were many people waiting, when in came a strange young man dressed in hippy-style clothes. He asked for drugs.

I said "Sorry, I don't prescribe drugs just like that. I don't know you or anything about you."  "If you don't give me any, I'm going to report you to the B.M.A.". "What for?" I replied in astonishment.  "For having a lesbian relationship with a patient, Miss X". I immediately burst out laughing. It was so far from the truth that I did not feel in the least threatened and I told him to get out in no uncertain terms. I knew there were two strange girls in the waiting room, who had been with him. I called them in one by one and each in turn asked for drugs. Each time I replied "No". Each time they threatened to report me to the B.M.A. Each time I laughed in their face.

And as soon as the the third was out of the door I was onto the police who came round immediately. I was able to give them a detailed description of all three and the address they had given. The police were off in pursuit in no time at all and an hour later phoned me to say they had caught up with the charming trio in a pub in Stockbridge. They were not charged but given dire warnings and I never saw any of them again.

A third incident occurred which was more disturbing and illustrates that no matter how hard you try you can never please everyone. I had agreed to treat this young man very much against my better judgement. He seemed unstable but had good manners and was very persuasive. Nevertheless I had turned him down and one day his father came to me to plead his son's cause. He was very distressed as he had already lost one son, I think through alcohol abuse, and the poor man was really at his wit's end. His wife was of a very nervous disposition and was naturally very depressed, and he was finding it difficult to cope with both his wife and his son. "Please Doctor, please take him on. If you could regulate his dosage I can find him work with me and together we ought to be able to help him back to some degree of normality."

Reluctantly I agreed and after a long interview with the son we started a slowly reducing regime. For a few weeks all went well until one evening he came up to the surgery and I was sure he had been drinking. He had a long story which was meant to explain why he needed an increase in his particular medication. I naturally explained that, as he was already under the influence, there was no way I was going to give him any further medication and to come back on the right day for his usual prescription. He went off dejected but making no trouble.

At 2a.m. the phone rang. "Doctor White speaking" I said sleepily. 2a.m. is not my best time. "Doctor, this is South Side Police. We need your help. We have been called to a flat where a young man has gone beserk. He has been running around with a large kitchen knife and is now asking for you. He is now sitting with the knife turned on himself and says that if you don't come he will kill himself. I'm sure he means it and he won't let anyone in the room with him." "What a bloody idiot he is but, yes, I'll come" I replied and, after hastily getting into some clothes, drove over to the South Side, wondering what on earth I was going to do. When I arrived there were at least three policemen and a policewoman in the hall, all looking very worried. The father was there, extremely agitated, and I could hear the mother (who had hidden in a cupboard in the kitchen) howling like a banshee.

I was shown into the living room where the patient was sitting in a chair, crouched forward holding a large knife in two hands with the point against his abdomen. The others all remained in the hall. Trying to look as if this was an everyday occurrence, I sat down beside him saying something quite inane such as "Well lad. How are you? I hear you've been causing quite a disturbance. What is it all about?"

He soon began to weep, especially after I pointed out to him how he had upset his mother, but still sat firmly grasping the knife against his stomach. I talked away to him about this and that for about 20 minutes, when I said: "Look, let's put an end to this. You don't really want to die, do you? It would be an awfully messy business".

Slowly, very slowly, he began to relax. Still holding the knife, he took it away from his stomach and just held it loosely. Then he let it hang from his hand point downwards. I kept talking, mostly trivia, but encouraging him to relax and put down the knife. Then came the crunch. "I'll put it down if you will give me my prescription." "No, I can't do that and you know it, but what I will do is this. If you give me the knife I'll give you an injection of a tranquilliser." He was still weeping, afraid of going with the police and - I suspect - sick of the whole sorry situation. I reassured him the police would not harm him but explained he would almost certainly have to face charges in the morning.

Slowly he gave me the knife along with a timid smile and I gave him an injection of a major tranquilliser. Then I took the knife out to the police who were still waiting anxiously in the hall and who then went into the room and gently escorted the patient to a waiting van downstairs.

"My goodness Doctor, you did handle the situation well"...."Well done Doctor" were the kind of remarks with which I was greeted by the Boys in Blue as I came out of the room, but from the father I received a storm of abuse. In his opinion it was all my fault. I should have given him exactly what he asked for. Doctors are supposed to help people, why didn't I help people, and so on. He was so wound up I knew it would be useless to try and explain things so I just said: "I'm sorry you don't like my methods but your son knows he is free to find another doctor if he likes. Good night", and walked quietly downstairs and into my car and drove home.

It was several weeks later when the father came round to apologise for his outburst and to try and persuade me to keep his son on my list. This patient was not one of my success stories but we parted company still friends. This was about 10 years ago and if I happen to meet him in the street I stop for a brief word. He is still looking well but I don't know what his habit situation is now.

The second main problem (after threatening behaviour) in the management of drug addicts is the snow-ball effect. Word soon gets around that you are at least willing to see them and listen to them and so, before long, there is an ever increasing number on your doorstep requesting help. There is no immediate answer to this and you can only try to be as firm as possible with your established patients and selective with your new ones. About three or four years ago the number of addicts seeking help became so great that I had to say "No! I can handle no more", and refused to take any more on my list, although sometimes I would see them and try to direct them to other helping agencies. At the same time I had some of the more undesirable characters removed from my practice and life in the surgery became comparatively peaceful again. This problem would be easily solved if all GP's would be willing to take just a few addicts on their list. I believe, since the advent of AIDS, they are now being encouraged to do so. There was a time when I had the feeling that doctors who took on problem patients - especially drug abusers - were considered to be slightly down-market and not quite so respectable (in the true sense of the word) or even as professional as their more orthodox colleagues. I cannot vouch for other doctors, although I am sure there were plenty of others like myself, but I did my best to give just as good care and treatment to all my patients as any other GP, including those practising in the most salubrious areas and up to date surgeries.

With the advent of AIDS and all the accompanying publicity things changed, and those doctors who were willing to take on addicts and all their attendant problems became useful to the authorities. Social workers, hospital clinics etc. would ring me up and say "PLEASE will you take on this patient and their family. They can't find a doctor willing to have them."

The important thing with these patients, as with all drug abusers but more so, was to try and help them get some sort of order into their lives and, above all, to get them to stop injecting their own particular cocktail. If they persist in injecting then they must be persuaded to use clean syringes and needles and learn to dispose of them safely. This sounds self-evident I know and, one would think, easy to put into practice. Initially when AIDS first launched itself upon the scene the patients at risk were in such a state of shock that it was comparatively easy - many to my knowledge stopped injecting illegal drugs and were given oral substitutes at various centres and, if persisting in injecting, became very careful with their syringes and needles. But as time went on, I sensed that a few of the more irresponsible HIV patients said to themselves: "I've got the virus anyway so I might as well continue to inject".

I could understand their point of view but it was not a very positive attitude and certainly did not help them or other people. I did have a number of HIV positive patients but none, I'm glad to say, with full-blown AIDS. I often wonder how they are now, are they still well, or have any gone on to develop the full blown syndrome? They were just like other people - good, bad and indifferent - not a race apart, as some people seem to think. I remember being told a story about another member of the medical profession. This young man (whose case history I will not go into) had discovered he was HIV positive when he was admitted to hospital afer a serious accident. When he came home he still had difficulty in walking and his wife called in his GP to give him the discharge letter and obtain the required medication. When they informed the doctor that the patient was HIV positive, he went quite pale, picked up his bag and, backing out the door, asked them to get another GP. In defence of the doctor this was in the early days when AIDS had just hit the headlines and we were not sure just how infective it was.

The question now arises: "Did I have any success in my treatment or management of the drug abusers?" My answer is "Yes", but I had my failures also. A few patients managed to come off and remained off all drugs, but most fell somewhere between total success and failure because even success and failure are relative. If a patient can continue on a small maintenance dose of a particular medication and hold down a skilled job I would call that a relative success at the top end of the scale. If a girl can give up shop-lifting or prostitution, which she did to finance her habit, this is also a success - lower down the scale perhaps but very important when you consider the infectivity of the AIDS virus and its spread into the general population.

Any order out of chaos is a degree of success and always, always I had to be on the look-out for patients just looking for a soft touch, ready to take advantage of my good nature. One thing I quickly learned was that coping with addicts requires constant firmness, patience and above all a sense of humour. Not forgetting a back-up staff, and in that respect I was wonderfully lucky. I could never have managed without the help of my two receptionists Mrs McCann and Mrs Scott, who both showed infinite kindness and tolerance with even the most difficult patients.

I would not like anyone to think of this chapter as a dissertation on the treatment of drug abusers. No, it is only a brief summary of how I dealt with the problem and a few of my ideas on the subject.

In recent years it has been easier for the GP with an interest in the subject as there are now a number of treatment centres and clinics in different hospitals in the city, but when I took on my first addict there was virtually nowhere for that addict to seek help, except the Andrew Duncan Clinic who only offered a brief detoxification programme and virtually no back-up or follow-up service. I know of very few who actually managed to complete the programme. They were frequently put in a ward with severely psychotic patients and naturally they found this very distressing. Besides this they were given virtually no counselling or psychotherapy and came out feeling very despondent and disappointed in their treatment. They would be sent out into the wide world, into their old environment, among their old cronies, and soon fell by the wayside again.

As I said, things are very different now - thanks mainly to the HIV virus - and if a GP does decide to take a drug abuser on his list he has the support of various clinics and welfare services behind him.

Looking back, I do not regret taking on drug addicts. It was extremely hard work and on many days I was drained and exhausted but it could be very rewarding - not often I will admit, but sometimes. And, being quite selective with those I agreed to treat, I made many friends among them and they in their turn could be strangely protective towards me.
 

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