 
ABOUT THE BOOK

The birth of a baby should be a time of joy but sadly this is not always the case. Traumatic events and widely differing home circumstances shape the lives of the six main characters but through the adversity, shines resilience and humour, which often triumphs.

This novel gives a unique opportunity to glimpse a diversity of home life from cradle to grave, through the eyes of the Health Visitor.

### Joy Comes In The Morning

Christine Sleath

Copyright 2013 Christine Sleath

Published by Christine Sleath at Smashwords
ACKNOWLEDGEMENTS

With grateful thanks to my friends, colleagues and family, without whom this book would not have been possible.

The book is a work of fiction. The characters, incidents and dialogues are products of the author's imagination and should not be construed as actual events.

Smashwords Edition, License Notes

This book is licensed for your personal enjoyment only. This ebook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each recipient. Thank you for respecting the hard work of this author

CHAPTER ONE

It was my first day as a fully-fledged Health Visitor. After a year of hard work, I had the coveted qualification and was going to revolutionise the lives of all my clients from the cradle to the grave.

In the late 1970's most Health Visitors worked from a health centre. They were loosely linked with GP surgeries, but the doctors, and probably a large proportion of the general public, were mainly ignorant about their work. I had been a hospital sister prior to my career change, and friends and family were amazed that anyone should wish to give up such a prestigious position to become "a sort of social worker."

The career change necessitated my learning to drive, which was a source of some amusement to our two children but almost grounds for divorce from my husband. I did pass my driving test the first time. This news was met not with hearty congratulations but by incredulity from my better half. After suffering his unbridled but often justified wrath during my attempts to drive his beloved vehicle, I had found the dreaded examiner to be chicken feed. It is true to say that the car had suffered not only many minor dents with me at the helm, but also two major ones. Fortunately, in the worst accident with a delivery lorry no one was hurt. The driver of the lorry, which I was sure there was enough room to overtake, was most sympathetic on seeing my hospital uniform and said he would not claim. Now of course I was not protected by a uniform, but my trusty little Mini, which cost me £30, was to remain unscathed during my work as a Health Visitor.

My missionary zeal had been somewhat deflated when I realised the experienced Health Visitors at the centre did not appear to be quite so enthusiastic. Though they were obviously working hard, the problems were multiplying. Nevertheless I had attacked the filing system and prepared with vigour (and some niggling trepidation) for my first challenge, the baby clinic.

Baby clinics were usually held in church halls or in working men's clubs. This particular one was in a miners' welfare hall and was attended by parents from different social levels, but a large proportion came from a sprawling council estate or lived in the miners' accommodation, as this was before the massive pit closures. Many parents were both single and needy but a few were extremely affluent and information given had to be tailored to individual requirements.

I let myself into the building clutching an armful of health information leaflets and a box of toys to brighten the place up. It was dark and gloomy and the one ancient central heating radiator was almost totally ineffective. The rusty brown cupboard housing the baby scales refused to yield to the turn of my key. I could already hear people filing into the building and children shouting and babies screaming. Suddenly, when I had begun to despair of ever setting up my first clinic and dispensing my valuable advice to all who would listen, there burst through the door, like a breath of fresh air a large, friendly lady. This was Marjorie the Welfare Assistant. She was in her mid forties, with thick, brown, curly hair, rosy cheeks and spoke with a strong local accent. Indeed, her speech was so quick that all her words came tumbling out one after the other, the one following the next before its completion. Marjorie's official job was to sell the subsidised baby milk or to issue it freely on the production of tokens, but in reality, she did much more than this. Her first important and welcome job was to open my cupboard. I had the key, but Marjorie had the knack. With one deft flick of the wrist, the door was opened when it had stubbornly refused to budge to my coaxing, kicking and exasperation. Marjorie placed a semi-circle of chairs around my box of toys and left me to dust down the table in readiness for my scales, the tools of the trade.

The chairs were filling up nicely. Mothers and children appeared to be congregating into three distinct groups. One small group was obviously made up of middle class, professional, articulate mothers. They filled me with trepidation, as I knew from my experience as a student Health Visitor that they would probably be well read and have heard every television documentary pertaining to babies and childcare. Would I be able to supply them with the correct information? The second group, which was probably the largest and certainly the most vociferous, came from the nearby estate. They all knew each other and everyone's extended family. They had lived in the same area for all their lives and rarely left the town even to take a holiday. Their children were extremely noisy and often uncontrolled. Some of the mothers surprised me when I learnt their age because frequent child bearing had made them look much older. One young, single parent told me that her mum was too old to be much help with the kids. She was actually only forty-nine! The third group was not really a unit at all. They did not talk to each other or to anyone else. There was one lady with a severe psychiatric problem, a father who was there under sufferance, and one mother who had recently moved into the area.

I indicated that I was ready but no one seemed eager to see me. Marjorie had begun dispensing tea and coffee, with squash for the children and they were all managing perfectly well without the Health Visitor. On my second call, the extremely disturbed lady shuffled forwards. She held her baby daughter at arms' length and undressed her just as a child would undress a doll. She neither spoke to the baby nor did she maintain any eye contact. Her eyes were staring and her face was chalk white and devoid of any make up. She looked as if she had not slept for a long time. I tried, without success, to strike up a conversation. She told me only that her name was Julie and the date of birth of her daughter Katy, now three months old. I gleaned no other information but made a note to discuss her case with the doctor. Katy was a well-nourished little girl and was the right weight for her age. I was quite surprised how easy it was to make her smile, and concluded that either Julie was not always so depressed or that there was someone else helping with her care. A home visit was certainly indicated in this case as soon as possible.

Feeling rather like a lady at the DSS I shouted, "Next!" The father had a list of questions, which were easily answered. He ticked them off on his list, dressed his son and made a hasty exit. The lady who had moved to the area was pleased to be given information about various groups and activities in the neighbourhood and she did at least make me feel that I had been of some use.

The articulate group was strangely reluctant to ask any questions about themselves or their children. They simply wanted to have their babies weighed and then leave, presumably to do something much more interesting. One or two of them did want to know if I had any children; to me it seemed sure that a negative answer would have meant losing all credibility.

Even though previously anxious about the types of questions that might be asked, I felt that my training hardly came in to use. I learnt when I had been in the area a little longer that it was the lack of privacy which made many of the mothers reluctant to seek advice. They were frightened that they would be overheard asking either embarrassing or inappropriate questions. When I eventually moved to another private room in the same building they talked more freely.

The large group remained and had been joined by a few more. The babies were crawling amongst the toys. The older children were hurling the playthings across the room and spilling their squash. Their parents were more interested in talking to Marjorie and to each other than in controlling their noisy offspring. Every so often a child would indicate he needed a "wee wee", and when the shouts became insistent they were reluctantly taken. Marjorie was obviously resigned to the odd accident, because she had a large mop and bucket strategically placed to deal with the puddles. If the members of this group could tear themselves away to see the Health Visitor, I thought that they might not be so reluctant to ask questions.

Just as I was about to see the first one, a wild-eyed man burst through the door. "Is there a doctor here?" he shouted. "My grandson's in trouble."

"What exactly is the problem?" I said. "We don't have a doctor in the clinic."

"He's red in the face and making funny noises. Can you come? It's only round the corner." As he spoke he was already on his way out of the building. It was impossible to ask any further questions. I ran with him, not even bothering to pick up my coat, though it was raining very hard. Part of me hoped that it would not be too far, but another cowardly side was hoping that the crisis would be averted before we reached the house. What on earth could be the matter with the child? I did not even know his name, or age, or anything about him. Would I be able to cope after a year away from hospital and acute cases? In hospital they had all the equipment for resuscitation, as well as many highly qualified medical staff. Here I would be alone, facing an unknown situation with no one else to help me. All sorts of unpleasant thoughts entered my head. It could be an obstruction or meningitis. All I'd ever learnt was now forgotten. I'd always imagined myself to be relatively fit, but now my heart was pumping fast enough to be heard. I tried to ask the man some more questions as we raced along, but could not manage to get any words out. My throat felt dry and my tongue hugely swollen.

When we arrived at the house I was as exhausted as if I had been running a marathon, but it was actually only a few hundred yards. A lady in her mid fifties, probably the grandmother, was standing at the door. She had tears rolling down her face, and I immediately imagined the worst. "Thank God someone's come," she said. "The babby's gone all white and doesn't seem to be breathing." This confirmed my previous fears, but I dashed into the room where a young girl was shaking a pathetic little body from side to side. The baby was about fourteen months old. He was deathly pale. Nevertheless the pulse in his little neck felt fairly strong. Greatly reassured, and my panic abating slightly, I felt able to ask some questions. "Has anyone called an ambulance?" seemed the most important.

"We tried," said the grandfather, "but we haven't got a phone, and the one at the end of the street has been vandalised." I suggested that he should try a neighbour, as it was important for the child to go to hospital. The next thing was to find out some sort of history.

"He was playing on the floor," said the young girl. "Then he started shaking and banging about. We couldn't hold him down and he was bashing his head on the floor. He went all purple but never cried. Oh, it was terrible to see him." This account of the incident caused her to have a fresh bout of weeping.

"Then, what happened next?" I prompted. But while listening, I was also checking the little boy's mouth, looking for any obstructions.

"He just went like this. He won't smile or look at me or anything. Oh, if only he'd cry."

Grandma was told to go and fill the sink with tepid water. Meanwhile, I was taking off the boy's clothes. It was very warm in the living room. The gas fire was full on. Nevertheless, the child was dressed in a nappy, a thick woolly vest, warm trousers, shirt and a chunky jumper. Just before putting him in the sink bath, I sensed that he was starting to come round. However, as the water came into contact with his body he gave a piercing yell and then cried lustily without pausing, as only young toddlers seem able to do.

At that moment grandad returned. "I've called the ambulance," he shouted. "They're coming at once.

"We don't need it now," said his wife. "Look at him, he's come back alive!"

I told the young girl, the baby's mother, to wrap him in the towel. By this time we were all crying, myself included. "You'll need him checked over in hospital," I said. "Can his grandma pack him some things and I'll explain what's the matter with him. Was he hot, or did he seem to have a temperature?"

"Yes, he was burning up," said the girl, "and mum told me to wrap him up warm as he was probably coming down with a cold." This is a common mistake that people make when infants have temperatures, and now was not the time to contradict grandma, or to make them think that her advice had been in any way responsible. The hospital would tell them this and show them a video to prevent it happening again.

"He's had a convulsion," I explained. "It's caused by the body overheating with a high temperature. He'll be quite all right now, and whatever caused the illness can be treated if needed." They were not really able to take in any information. All they knew was that their baby who, they thought, had died was now alive.

The ambulance arrived with flashing blue lights. The paramedics checked the little lad as mum held him on her knee. The street was lined with people who were in no way deterred by the pouring rain. If a phone had been needed now, there would have been many willing householders to offer this facility. Those who had not braved the driving rain were twitching and peering through net curtains. Reverently, the girl carried her small child wrapped in his fluffy yellow towel to the waiting ambulance.

"Would you like a cup of tea?" said grandma.

"Give the lass a whisky," said grandad. "She's earned it." I looked at my watch and realised I had been absent from the clinic for thirty minutes. It felt much longer. My panic had now totally abated, to be replaced by that wonderful warm glow that all people who are fortunate enough to work in the caring professions experience from time to time. It was lucky that the man had chosen to run into my clinic for assistance and that this should happen at the start of my career. It would certainly do me no harm when the news got around, as it surely would in that close knit community.

On arriving back at the baby clinic, my moment of glory quickly subsided. The scene was exactly as I had left it to go on the emergency call. The large group was still chatting, Marjorie was laughing uproariously, and the mobile infants were continuing their mayhem mainly unchecked. The clinic would have probably functioned very well without a Health Visitor to dispense advice.

Undaunted, I seated myself behind the scales and called for the next customer. A girl who looked to be about eighteen came forward. She was not as confident as the others in the group, but was obviously well known by them. She told me her name was Susan. She had two children, a baby, Shane, who was four weeks old, and a girl, Sharon, who at a year old had just started to walk. Susan was a small plump girl with light ginger hair that was dry with split ends. Her skin was pale with a sprinkling of freckles and she appeared rather apathetic. Conversation was difficult. I tried to steer away from topics that might cause her embarrassment and stick to general chat, but I was anxious to get to know her, as it seemed she might need some help. She was wearing a hearing aid but did not seem to have much difficulty with normal conversation. I weighed Shane but not Sharon at this stage, as toddlers not surprisingly are prone to cry when undressed and plonked on cold scales. Shane had put on far too much weight, given his birth weight on his card. Experience as a student had taught me that you must never use words like "fat" when describing someone's precious offspring, or indeed the mere suggestion of overweight. "What do you think about Shane's weight?" was my tentative question.

"I don't know," she said. "Is it all right?"

This gave me a slight opening but I had to tread carefully. "If he was just as contented but not putting on as much weight, would that be OK for you?" I said.

"Yes, I suppose so," she admitted. The baby was bottle-fed. Susan was receiving social security benefits and qualified for milk tokens, so all the baby's milk was free. Whether it was this incentive which was the motivation I did not know. Certainly it was and still is mainly the middle class professional mothers who choose to breast feed. I suggested that she changed to different baby milk, which could be given in the same amount but should satisfy him longer. I asked if I could call in to see her at home to find out if it was doing the trick? She agreed to this, albeit reluctantly, but at least it gave me an excuse to do a home visit. Then she shuffled over to Marjorie's table where the various tins of milk were displayed.

"Can I have some Delimilk?" she said.

"Help yourself, love," said Marjorie, taking the tokens. Susan took two tins, which were nothing like the name I had advised.

"Actually this one would be much better for you," I said, giving her the correct brand. It was then that I realised Susan probably could not read, and made a mental note to try and find out when visiting her at home.

The time for closing the clinic was quickly approaching, so it was only possible to weigh the rest of the babies while giving the most cursory advice, which was seldom requested. I asked the mothers if they would get the older toddlers to put the toys back in the box, but this request was met with no immediate response. Marjorie repeated the request with slightly more effect and much shouting from the mothers.

"Put them cars back in that box!"

"Pick the bricks up!"

"Go on, do it or I'll smack you!"

"You won't get any sweeties on the way home!"

The toddlers totally ignored their parents. One small girl did put a teddy in the box, but wasn't praised for her action, so she didn't repeat it. The toddlers ran in all directions. The mothers were severely hampered by their babies in arms. They finally gave up the effort of shouting, and some dropped a few toys in the box. Marjorie and I did the rest and restored the room back to its normal state.

As we were leaving the building, I mentioned to Marjorie that the mothers had not been very forthcoming. "Oh, don't worry love," she reassured me, "they'll soon get used to you."
CHAPTER TWO

In order to get used to me, I had to get used to them. Where was the best place to start? Saxford was a town with very mixed housing estates all in close proximity. From my experience at the baby clinic, it was obvious that the various groups of people would have different needs and expectations. Susan was expecting a call and Julie also needed to be seen. There were statutory visits to be made, which were in our professional guidelines, but Saxford had been without a Health Visitor for a long time and home visits had been neglected. The clients had seen so many different faces, usually just at the clinic, that no sort of relationships had been formed.

I called in at the surgery to find out more about Susan and Julie and to pick up any other visits. At this time it was mainly children under the age of five who were referred to the Health Visitor, but when the doctors got to know me better they asked me to see other age groups, especially the elderly. Surgery was in progress. There were three doctors working that morning and the small cramped waiting room was full with several patients standing. The practice manager who had been there for many years clearly knew the patients quite well. She greeted me with some reserve but was not unfriendly. She showed me where the patients' notes were as this was before the days of computerised records. She handed me three new files on babies recently born.

I discovered that Julie had not brought her baby for immunisation nor had she attended for her postnatal check. She had a history of depression in her teens and had actually been admitted to hospital when she was sixteen, following an overdose of paracetamol. She was not, however, known to the doctors in Saxford, because she had only moved there just after the birth of Katy. Susan had lived in the area all her life. She had been taken in to the care of the local authority at three, but the reason was not clear on the medical records. There was a mention of mild hearing loss, which seemed only to have been discovered last year. Sharon, her one-year-old daughter, had several episodes of diarrhoea recorded and two admissions to the local hospital for gastro-enteritis. She also had a sticker on her notes, which the practice manager told me indicated several inappropriate night calls to the doctors. She would be asked to find another doctor if it continued.

Armed with an up to date map of the area and my child health records, I set off enthusiastically for my home visits. It was mid October. The air was mild and a watery sun was peeping through the thin clouds. My first visit was to a single mother in a nearby block of flats. I found the road easily without having to stop to look at my map. All I had to do was to find flat number 103. Half an hour later, not quite so enthusiastic, and considerably wet, as the watery sun had disappeared behind the thickening clouds, I was still searching for the elusive number. I could find all the numbers adjacent to 103, but just when I was sure the next flat would be mine, a totally different number appeared on the wall. Whoever was responsible for the numbering of that estate must have put all the numbers in a bag and pulled them out like a bingo caller. Finally when considering abandoning the visit until more detailed instructions could be obtained, I hit the jackpot. It was an upstairs flat, which meant carrying my baby scales up three flights of stairs. The stairs were grey concrete, uncarpeted and smelling of stale alcohol and urine. There were two polythene bags in the entrance, which had probably been left by youngsters after a glue-sniffing episode. The area looked run down and neglected. I could hear the barking of a dog, which sounded very fierce and hoped it would not be in my flat. Pausing for a moment to recap on the purpose of my visit, which was to see the mother and ten day old baby, give any advice needed and discuss the immunisation programme, I knocked on the door, praying it would be answered but not by the barking of the fierce dog.

My prayers were answered! A young woman, who looked to be about twenty-five, though her records said she was only seventeen, answered the door. She had bare feet and was dressed in a large T-shirt with nothing underneath. She was smoking a cigarette with one hand and was holding the baby in the other. The flat was clean and fairly tidy but reeked of cigarette smoke. After my outdoor activity searching for house numbers this caused me to cough and splutter. The baby was duly weighed and examined and we discussed feeding. She was a friendly girl from a large extended family and handled the baby well. I tried to broach the subject of smoking in the same room as the baby, but this was met with such naked hostility that it was important to tread very carefully. We then got on to the subject of immunisation. She had already had her ten day old daughter's ears pierced but was very worried about her having her jabs as this would involve sticking needles in her! I managed to persuade her to agree to this treatment for her daughter but then needed to ask her some relevant questions. The medical history of her own family was easy.

"Is there any history of fits or convulsions in the father's family?" I asked.

"Eee love, I don't know," she said, looking at me rather blankly. "I don't know anything about him. I don't even know the colour of his eyes."

"Forgive me for asking you" I said. "But how did you manage to get pregnant?"

"It was easy, I just wanted a babby so I went to 'fairground and just went with a bloke." I wasn't really prepared for this information but decided that it gave me a perfect opening to discuss contraceptive advice. Like the smoking discussion it once again fell on deaf ears, and I had to content myself with the immunisation success.

Susan lived on the same estate but in a house which was relatively easy to find. Most of these properties looked very run down and the gardens had been neglected, some having old furniture, washing machines and burnt out cars deposited in them. The back gardens were long and thin. The occasional one boasted a vegetable patch. Generally those which were well tended belonged to the elderly.

The rain had stopped as I approached Susan's house via the back door. It was rare for people on this estate to use the front door and usually impossible. Toys, prams, or other miscellaneous objects often blocked them. I knocked at the back door and could hear a baby crying. After several attempts to make someone hear, I cautiously opened the door. The back room was a living area and kitchen combined. The overall impression was of a complete disorganised mess. There were greasy pans, plates and dishes on every conceivable surface. Tins had been opened and left with half eaten, sometimes mouldy contents. Bread and butter and crisps were scattered about and a cat's litter tray was tipped up amongst the rubbish. It looked as though there had been a recent burglary. It took me a few seconds to register this chaos, when my attention was drawn to the renewed crying of Shane in his carrycot on the floor, which had been temporarily hidden by the clutter. Sharon was also in the room but she was sitting very quietly in a corner, eating what could once have been a jam sandwich, but was now embellished by pieces of fluff and other unidentified debris. She stood up on seeing me and tottered in my direction. Then it became obvious why the room was so warm, as Sharon was passing within inches of an unguarded coal fire. I picked her up and she deposited a streak of sticky red jam on my cream blouse. She then nuzzled into my left shoulder leaving a trail of green nasal discharge.

"What the bloody hell are you doing in my house?" shouted a tall, thin man with long, greasy, mousy brown hair as he burst through the door.

"I'm really sorry," I said. "But I did try knocking, then I heard the baby crying so I came in. I'm the Health Visitor. I mentioned to Susan when I saw her at clinic that I would call."

"She's out at the shops, she won't be long. I was down in the shed at the bottom of the garden."

"I'm a bit concerned about Sharon being alone in the room with an open fire" I ventured. "She could easily get burnt." I was totally unprepared for the reaction this caused. The man came up to me menacingly and placed both his hands firmly around my neck. His face was suffused with angry red blotches and I was petrified.

"You bloody do-gooder" he said. "Why do you have to come meddling in our business?" Flashes of training in dealing with aggression shot through my head. The first essential thing was not to shout back and to try to keep calm. With my neck in the vice like grip, this was not difficult as I was paralysed with fear.

"Please," I managed to whisper. "I don't mean any harm. I only wanted to see if Susan was finding the new baby milk better." He let go of my neck and burst into tears. At that moment Susan came home and her partner went back out into the garden.

Susan was much more talkative in her own home. She picked up the baby who had started crying again and gave Sharon, seemingly quite unaffected by her father's outburst, a chocolate biscuit.

"Has he been upsetting you?" she asked. "He gets like this. It's not his fault." She told me that Ken got mood swings from time to time and that he was very frustrated because he couldn't get a job. He had tried training schemes but couldn't get on with the other people and never finished. She said that he was all right with her and the children and she just left him alone when he was in one of his moods. Shane was put on the scales. His weight was much better, the new milk was obviously suiting him. Susan needed to give him a feed and started to prepare it. There was a grubby container on the side of the sink amongst all the dirty dishes and rubbish. Susan plunged her not very clean hands into it and extracted a bottle.

"I'll just wash my hands and help you," I said, hoping she would take the hint, but at the same time wary of the reaction my last criticism had provoked.

"It's got that sterilising stuff in the water," said Susan. "So you don't need to wash your hands." I explained why it was necessary and she listened with interest. She then offered to make me a cup of tea while I fed the baby. I agreed, trying not to dwell too much on the many germs that surely were lurking in the cracked mug she had given me.

Whilst feeding Shane and drinking our tea, Susan told me a lot about herself. She had been brought up in different children's homes and foster homes and did not know anything about her real parents. She was deaf as a child and was sent to a school for educationally subnormal children, as her deafness had not been discovered and she was thought to be slow. I mentioned that it was probably not so easy to learn to read at a special school and she said she had been absent a lot because she wasn't happy there that is why her education had suffered.

"I feel so ashamed," she said. "What will happen when our Sharon goes to school? She'll find out I can't read." I told her about local classes where she could learn to read and managed to persuade her that she could have one to one tuition at first, because she was nervous of being in a group.

"There is a creche available for your children and I'll come and collect you the first time." I said.

Before I left we talked briefly about safety issues. She was quite receptive but money was obviously in short supply. She and Ken had actually met at the social security office whilst collecting their benefit. She was twenty-four and he was fifteen years older and probably made her feel more secure. She went to live in his council flat and they were rehoused when Shane was born. We were able to issue cards to people on low income to buy equipment like fire guards at greatly reduced rates, so I gave her one for the things needed.

"You'll come again won't you?" were her parting words and I reassured her that I would.

What a contrast to the run down estate of my last call, was this next new birth visit. It was in a leafy avenue. The houses did not have numbers but all boasted different names. Whilst driving along searching for my house which was called "Bryher", I looked at the names of the other large, detached properties and wondered about their origin.

The door was opened almost immediately in response to my ring. It was the front door, of course. Claire stood there with a welcoming smile on her face. She looked like a model despite her recent pregnancy. She was tall and slender with long dark glossy hair, large brown eyes and a marvelously clear complexion, with just a slight hint of make up. She was dressed in well cut obviously expensive jeans and a pale blue cashmere sweater. It made me more conscious of my own dishevelled appearance, not only a result of the rain but also the unpleasant stains Sharon had smeared on my blouse.

"Come in," she said. "We've been expecting you to call, the midwife said it would be today. Simon's not at work, would you like him to make you a drink?" Simon, her husband, was in the lounge. He greeted me warmly and then went to make the tea. Simon was a dentist who had taken a week's holiday to help Claire with the new baby. He was tall with blond hair. He had a muscular physique and the most amazing blue eyes. I made a mental note to change my dentist as even an extraction would be bearable whilst gazing into those eyes.

I do not usually note houses much when visiting clients, unless there are things about them which could adversely affect the health of the children. Simon and Claire's house was different. The lounge where we were sitting was huge. It looked like every detail had been planned by an interior designer. The French windows overlooked a delightful patio. The gardens beyond were vast and resembled the grounds of a stately home. The windows were draped in cream and pink floral curtains, which looked heavy and costly. The thick pile carpet was pink and the furniture soft cream leather. Everything about this room and indeed the entire house was tasteful and expensive. In one corner of the lounge was a pine wood swinging baby crib. I went over to it congratulating Claire and Simon on the birth of their first son. Adam at eleven days old was lying awake. Sometimes it is difficult to enthuse about a baby or to find any feature to praise, but it is always expected. With Adam there was no problem. He had a round dimpled face and light brown hair framing his head softly. He had been born by caesarian section, so that there was no moulding or bruising of the head which is common in newborn infants. Claire told me that they had been trying for ten years to have a baby and she had been having private treatment to aid conception. Adam was duly weighed and was just above his birth weight. Claire was breast feeding him and we discussed a few minor problems. Simon dressed his son and we continued chatting whilst drinking our tea, served of course in bone china cups. "Where did you meet?" I said, noticing a large framed portrait of the happy couple on their wedding day.

"I was working as a dental nurse in Simon's practice," Claire said.

"I asked her out a long time before she would agree" replied Simon.

"They were all after you at work," she said. "You were too sure of yourself." Curious about the name of the house I asked them how they had chosen it. .

"It's named after Bryher, one of the Scilly Isles where we went on honeymoon" said Simon.

Saying goodbye to this charming couple, I couldn't help comparing them with my other visits of that day. Adam was so wanted and loved. He would have all the very best care and attention from both his parents.

Following a quick lunch break and a couple of routine home visits, I decided to leave one of the new birth visits until the next day. It was to a lady who did not speak English and could be lengthy. The visit to Julie was probably more important. This turned out to be the right decision.

Julie lived in a semi-detached house about half a mile from the surgery. The houses were fairly modern and well numbered and there was no problem finding it. David, her husband, opened the door. He appeared to be in his mid thirties, and had dark wavy hair and a small moustache, but the first impression was that of a man who was extremely worried. I introduced myself and he invited me in.

"I'm really concerned about Julie," he said." She won't get out of bed and she won't see to Katy. I've had to stay off work." I explained my concerns when she had called in the clinic and asked to see her. Julie was lying curled up in the double bed. She was turned away from the door and did not look round when it opened. She was not asleep. Her face was still very pale, and her eyes staring. I tried several questions but there was no response. Finally I tried,

"Shall I go and fetch Katy?"

"No don't get her," she protested. "I don't want her. Just leave me alone." Going back downstairs I asked David what she had been like with Katy. He appeared to be very reluctant to discuss it with me.

"It's fairly normal for mothers not to like their babies," I said. "Especially if they are suffering from post natal depression like Julie." This gave him the confidence to tell me that Julie had said she hated her daughter and wished she had never been born. From last night she had refused to pick her up and had even said she would drop her if made to do so.

"I don't know what to do," he confided. "Her parents live on the Isle of Man and she doesn't get on well with mine who live in Birmingham. I don't want them to take Katy off us." I told him that the doctor would arrange for the psychiatrist to visit Julie that day at home. It was likely that he would arrange for her to be admitted with Katy to a mother and baby unit where she could be treated. After phoning the doctor there was time to talk to David. Katy was sitting in her baby relaxer chair. She was cooing and smiling, occasionally banging the brightly coloured mobile which was suspended over the seat. Striking one of the objects was merely by chance, but caused Katy to wiggle her legs with excitement when she hit the target.

"Well, Katy has certainly come to no harm," I said. "She is making excellent progress for her age."

David told me that he was a computer programmer. Computers were a mystery to me but David became quite animated when talking about his job. He described in some detail the latest computer techniques and I tried to appear interested. During the conversation he kept smiling at Katy and rocking her chair and it was obvious that he had put a lot of input into her care. I asked him about any medical problems Julie had in the past.

"We've only been married for just over a year and we met at a dating agency. We haven't known each other for very long," David explained. It seemed obvious that David had little experience with women and Julie had probably been his first girlfriend. They were both thirty-three. He said that she was sometimes quiet and sometimes chatty but that she had never been as bad as this. They had moved to Saxford because of his job. Julie was glad to give up her teaching post as she found discipline a problem.

Before leaving the house, I advised David to pack up some things for his wife and baby but not to leave Julie alone with Katy. Although I did not go into graphic detail, there is always a very real danger that mothers who are as depressed as this will seriously harm their babies. It was highly likely that she would be admitted to hospital that same day.
CHAPTER THREE

The next day brought news that Julie had been admitted to the mother and baby unit. It would be easy to visit there to discuss any treatment and to get to know her better.

Fatima was an Iranian lady who had recently given birth to her first baby. The midwife at the surgery told me that she was living with some friends who spoke English but that her English was very poor. Apparently, she was in her late thirties, and had already lost three babies at various stages in the pregnancy, whilst in her own country. She had come to stay with relatives in England in the fourth month of her pregnancy to try to ensure a healthy full term infant. Fatima was living on the same estate as Julie in a semi-detached property. The house had four bedrooms and it didn't take very long to realise how overcrowded it was. I discovered during my visit that there was Fatima, her husband Sohail and the baby in one room. The second bedroom was shared by another Iranian couple who were studying at the university. In the third bedroom was an elderly couple, who I discovered later actually owned the house and were Fatima's parents. In the fourth bedroom was a retired couple who had come to Saxford to be near friends. From time to time various young people appeared who were obviously students, but I could not imagine where they were all sleeping. In my encounters with Fatima, I was very relieved when one of these students was in because they all spoke excellent English.

In response to my ring, Sohail opened the door. He spoke little English at this stage but had a wonderful smile. At once, he made me feel most welcome. There was a through lounge, which was very cluttered, but quite clean. Many Eastern pictures and ornaments adorned the plain walls, but the most noticeable feature was the number of plants. There was so much greenery that it made the room look smaller than it actually was, and temporarily obscured the occupants.

Fatima was sitting cross legged on the floor feeding her infant daughter from a large pendulous breast. She was small, less than five feet tall and almost the same width. She seemed blissfully unaware of the adults in the room but was gazing adoringly with her dark brown eyes at the baby. The baby had been born four weeks early by caesarian section, as Fatima's pelvis was too narrow for a normal birth. Thankfully today a student was in the house. He was a young man who spoke excellent English with a mere trace of accent. I learnt that the baby was called Zora, the parents were delighted with her, and were not at all disappointed that their first born was a girl. The baby was small but had gained weight since birth. This was not surprising as she was apparently plugged on to her mother's breast all day, except when she fell off exhausted. When asleep, she was passed around to be nursed with many willing hands ever ready. She had a large sucking blister on her upper lip and it was possible to reassure them that this was quite normal and not causing Zora any pain. They were quite happy to agree to all the vaccinations. Fatima embraced me and kissed me several times. The student then said that the first visitor outside the family to see the new baby must have a drink with a special sweet cake to celebrate the birth. I established that it would not be alcohol and chose tea rather than coffee. The "drink" came on a tray covered by an intricately embroidered cloth with a bird design. It bore no resemblance to tea and was served luke warm in a small bowl. On the surface, like little islands, were floating lumps of a sort of buttery solution, probably some kind of milk. It was accompanied by a large square, a kind of cross between Turkish delight and nougat. The first bite revealed that it was loaded with sugar, causing me to fear for my fillings, but then I remembered Simon the handsome dentist. The "drink" was impossible to swallow. Wary of giving offence on my first important visit, I tried to wash it down with mouthfuls of the sweet cake, but it was causing me to heave. There were at least four people in the room at any one time, but I was granted a moment of reprieve when Zora started to splutter on her copious fountain of breast milk. All the adults hurried towards her. Quickly, I poured my remaining liquid in the nearest plant container, then walked over to the baby who had by this time recovered. Fatima and Sohail were so very friendly and anxious to ask for advice that it proved to be a long visit. I promised on leaving to call again soon.

There was just time to collect Susan and her children, to take her to the first reading lesson at the local adult education centre. Susan was pleased to see me but seemed very nervous. I sensed that it wouldn't take very much to make her decide not to go. Ken was in the kitchen/living room watching television. He didn't get up from the easy chair, or acknowledge the fact that his wife and children were going out.

Whilst we were driving to the school, Shane was sleeping. Sharon was very quiet, being in a car was probably a novelty.

"They won't give me baby books to read will they?" asked Susan.

"No," I replied. "They have special books for adults. They'll try to find something you're interested in and start you off with that."

"But what if I can't do it?"

"You will be able to," I reassured her. "The only reason you didn't learn at school was because you weren't hearing well and ended up at the wrong one."

On arrival at the centre we put Shane and Sharon in the creche. Sharon went straight over to the toys and was perfectly happy without her mother. This probably helped to reassure Susan. When we found her teacher she immediately put Susan at ease. She didn't appear in any way patronising and spoke with the local accent. She even said she would take them home, as Susan was her last pupil, and she would be driving through Susan's estate on the way to her house.

There was just time before lunch to pay a visit to the local gypsy site, or travellers as they preferred to be called. The site was actually half a mile out of Saxford. Not surprisingly, the people in Saxford weren't happy about it. It resembled a junk yard and looked run down, dirty and untidy. There was a water tap but no toilets. The travellers never had toilet facilities inside their caravans, because they considered this disgusting and filthy. However, they did not mind excrement on the site. The same was true of rubbish, which must never be kept inside their living space, but was thrown out on to the surrounding land without a second thought. When you added this household waste to the scrap metal, it is easy to visualise the normal state of the site. Scrap metal dealing was a popular trade with the travellers. Fortunately, I had visited this particular site several times as a student and was tolerated by the occupants. They were usually fairly polite to those Gorgios (their name for non-gypsies) who they considered to be official. Contrary to public opinion, they did not set out to cause trouble. No one stayed on the same site for long, so it was impossible to really get to know them. It was important to understand some of their customs in order to avoid causing offence. My purpose in calling today was to try to vaccinate a three-month-old baby, who had supposedly moved from Glasgow. The previous Health Visitor had contacted the surgery informing them of the impending move. Quite often, the travellers gave false information, or simply changed their minds about their destination at the last minute so I was not very hopeful of making contact.

There were two or three mangy looking dogs on ropes at the entrance. Immediately a man approached me who was a sort of guard to the camp. He pointed out a caravan saying that there was a three month old baby boy there recently arrived from Scotland. Happily it wasn't raining as I picked my way carefully through the assorted human and animal debris, knocking on the right van.

Inside the caravan were the parents of the baby, the grandmother and three older children. The children had been playing outside and had just come in for a drink. The father immediately left, as traveller women never discussed anything to do with sex or childbirth in front of males or pre-pubescent children. After exchanging pleasantries, the three children were packed off outside. The grandmother offered me a cup of tea. This was most unusual on a first visit. I agreed, knowing it would be served in a cup reserved especially for Gorgios, as they would consider it to be contaminated after being used by an outsider. The interior of the caravan was a complete contrast to the outside of the site. It was immaculate, as I had always found them to be. The furniture was spotless, the floor extremely clean, and all the various brasses and knick-knacks polished and shining. Around the walls were expensive Crown Derby ornaments, all lovingly arranged. It was a fascinating place. Not wanting to appear rude by staring, it was impossible for me to take in all the splendour of the beautiful objects decorating the room.

The baby boy was called Henry. He was in a carrycot but had woken up when I arrived. He was cleanly, if rather warmly dressed. His mum said it would be all right to weigh him. I assumed he would be bottle fed, as gypsies consider breast feeding rather distasteful. They would never breast feed in front of anyone, and this would be almost impossible given their living conditions. I felt sure that the bottles would be prepared hygienically, because they had strict rules about food preparation. Henry was weighed with his nappy on. It was a mystery to me where they changed the nappies but it was definitely not inside the van. After complimenting the mother on her lovely baby, I tentatively broached the subject of the first vaccination. Much to my surprise she agreed to tetanus, diptheria and polio with very little discussion. I did not even try to get permission for the whooping cough vaccine because adverse television publicity had effectively put these families off. The next hurdle was where to wash my hands. The sink in the living area had a bowl, which would only be used for dishes. It would be contaminated if used for other purposes. My request produced a bowl, which was taken with some soap, out of a cupboard. It was placed on a surface well away from the sink. When I had finished, the contents off the bowl were immediately thrown outside the van and the soap was returned to its cupboard.

The baby barely murmured when the needle went in. After the polio, which tastes terrible, grandma dipped a dummy in honey and stuck it in the child's mouth. Honey should not be given to children under the age of one, but keeping quiet about this information was the wisest thing to do. Encouraged by the immunisation success, I did venture to ask, if the two children who were obviously older than five had started at school.

"They don't need to go to school," said the mother. "What's the good of it to my kids? They can learn all they want with us."

"Our Thomas goes out with his dad," grandma chipped in. "He can already sort out metal. When we go out picking potatoes, they're as good as us."

"Wouldn't you like them to learn to read?" I said, wishing I hadn't bothered.

"What for," said the mother? "It's never done us no harm and they can reckon up money." She then launched in to a full throated attack on the school system, telling me how their children were victimised by the Gorgios. "They say they're dirty and they eat cats and hedgehogs. They laugh at their clothes. Now they hide when the school bus comes to pick them up."

It was obvious I was beaten, so simply leaving a card with the date of the next immunisation written on, even though they couldn't read, I planned to visit again the following month. If they had moved on, they could go to another surgery for the next injection. This was unlikely as they rarely attended hospitals or surgeries. They thought they would catch germs there and were probably right. Grandma offered to tell my fortune but I declined this offer and picked my way carefully to the car. It had been guarded by the man on gate duty and remained unharmed.

The same day brought me a very delicate visit which would need great tact and diplomacy. Laura lived about a mile from the town centre in rented accommodation. The houses were stone built at the turn of the century. When they were kept in a good state of repair they made excellent family homes having character and a degree of individuality. Laura's landlord often refused to spend the money needed for the upkeep of the property, but Laura and her partner Phil were not always prompt in paying the rent. I had never met the couple but was counting on someone being at home, as it was important to inform them about the results of a medical investigation.

Laura opened the door. She was twenty-four and had two children. The older boy Ryan was from a previous relationship. Laura was of medium build with brown hair tied loosely in the nape of her neck. It was difficult to tell if she was pretty, because it was impossible not to notice the livid bruising extending from above her eye to half way down her cheek. She told me Ryan who was four was with her parents.

We went into the living room, there were plenty of children's toys and the room felt warm, but the most obvious feature caused an involuntary shudder, and I wasn't surprised to learn later that one of the doctors had refused to visit the house. Resplendent in a large glass aquarium, taking up two thirds of the end wall, were two huge spiders separated by a partition. Laura told me that they belonged to her partner Phil. They were bird eating spiders but were fed twice a week on live blue bottles. They were kept apart as the female may eat the male after copulation. Following this discussion it was most difficult to concentrate as the spiders appeared to be glaring at me malevolently. Perhaps they thought I had brought their bluebottle dinner. It was necessary to move as far away from them as possible and manoevre my chair so they could not be seen.

"How is the baby?" I said "Are his eyes still sticky?" Patrick was three weeks old and had a persistent eye discharge.

"Yes they are, in fact they're worse, I'm having to bathe them much more" she said.

"We've found the germ that's causing it when we sent the swab to the hospital laboratory" I said "I've brought you some drops which will cure it and you will also need to give Patrick some antibiotic medicine. You must give it him all because it's a very nasty infection."

"How did he get it?" was the response I had been hoping for.

Taking a deep breath I tried to explain with as much tact as was possible under the circumstances, the cause of the problem. "Patrick has a germ called Gonococcus. He would have got it whilst he was being born from you." Laura was obviously well informed about such matters and knew at once that it was a sexually transmitted disease. She had perhaps experienced it before. It wouldn't be on her medical records because attendance at the special clinic is always confidential.

"I'll kill him", she said. "My poor baby, to do that to him. He's gone too far this time." I explained to Laura that his contacts would have to be traced, and she implied that they would have a lot to contact. Mindful of her black eye I asked her if she would like me to tell him, but was very relieved when she said she would do it herself. On questioning her about the injury to her face, she told me she had bumped into a kitchen unit, but this was probably not the truth.

Phil arrived home just then. How glad I was that the role of informer had not fallen to me. Not only would he and Laura have to attend the clinic, but all his partners, and it appeared there were many. It was easy to see why women found him attractive. He was quite tall with slim hips and broad muscular shoulders. He had wavy black hair and deep brown eyes with long curling lashes. His complexion looked tanned even though it was almost winter. He smiled at me showing even white teeth.

I left the house hoping that Laura would be able to tell him about the infection without causing an outburst of bad temper.

There was just time to call at one of the two schools on my patch. Fearn-Lea infant and junior school was situated between the council estate and the area of older dwellings where Laura lived. It was a grey stone built school with few modern facilities, but what this school lacked in equipment was made up for by the dedicated caring staff.

Going straight to the headmaster's office I was assured of a cordial reception. His children attended our surgery and they had a young baby who was often seen in clinic. Today's meeting was to discuss the possibility of starting a health education programme in the school.

"I'm really pleased to see you" he said, "I am quite worried about one of our pupils. Her name is Helen Smith, but as she is now five and half and has older siblings you probably don't know the family." He then went on to tell me that Helen came to school in a really unkempt state smelling of body odour and urine. "It's so bad" he said "that we keep a set of clothes at school, and Miss Hardwick changes her in the morning, but we daren't send her home in them because they just end up ruined." I asked him about Helen's height and weight.

"She is extremely small and thin" he said "and stands out in her class because of her size. Also as she smells so much none of the other children will play with her."

"What happened when she had her school medical?" I said.

"The school nurse was concerned" he replied "I believe social services are involved but the situation doesn't seem to be improving."

"Does she have school meals?" I said.

"No she brings sandwiches, but I don't think they can be very nourishing. Some days I let her have a free school dinner, she seems to really enjoy them."

I asked the headmaster if it was possible for me to see Helen without going into her classroom which would make it look obvious. He said he would send his secretary to the class to ask for some papers, requesting that Miss Hardwick send Helen with them to his office.

After about fifteen minutes, when we had discussed a dental health project to be started with the first year infants, Helen knocked at the door. She was very thin with a pallid complexion and lank light brown hair which looked as if it had been hacked not cut. From her height one would imagine she was only three instead of five. She was not in any way afraid of the headmaster and came right up to his desk with the papers. She spoke in a babyish voice quite slowly. When she was in the small office the smell was stifling. Even though she had the clean clothes on the stench of ammonia was patently obvious.

When Helen left to go back to her class, we agreed that I would contact the social worker for information and try to do a home visit to see if some light could be thrown on the situation. It was puzzling to discover that though Helen's brother and sister were not very clean, they were average height and weight for their age and there had been no major concerns.

The social worker confirmed their involvement with the family. She said she visited every few months but apart from feeling that Helen's mother drank too much, she didn't think the home circumstances were worse than many others.

The house was on the same estate as Laura's but was privately owned. Alan, the father, worked as a fitter in the local factory, so would probably not be at home. The front garden was mainly grass. There was a small border, which was overgrown with weeds. The lawn was scattered with dog dirt and paper rubbish. The paintwork on the front door was faded and peeling. There was no response to my knock. A passage led to the back entrance. At the end of this was a mongrel dog tethered to a piece of rope. It leaped out and narrowly missed me. Though it barked ferociously, once again the door knocking brought no response. The television was on so I cautiously tried the back door. The door wasn't locked and the kitchen was empty. It looked sparse and old fashioned. There was no evidence of recent food preparation.

In the living room Helen's mother Mary was sitting in an old armchair. She was staring into space and didn't acknowledge my entry. She looked unkempt, with matted shoulder length brown hair and clothes stained with food or similar. There was a strong smell of alcohol in the room. I approached the chair introduced myself and said, "I've just been to the school and we wondered if you were having any problems with Helen. Does she wet the bed?" Mary turned slowly towards me. Her eyes were dull and her complexion had an unhealthy muddy tinge. She spoke very slowly slurring her words.

"That one's a cow nothing but trouble."

"What about the other two?" I said.

"Oh they're alright" was the reply "It's that one who's no good." This small attempt at conversation appeared to exhaust her, and she slumped back into the chair closing her eyes, which discouraged further question. The gas fire was full on, and the stench of alcohol was now mingling with an unwashed sweaty body odour. The small room was cluttered with furniture, books, magazines and cardboard boxes. The stifling atmosphere combined with my warm outdoor clothes caused me to feel quite faint. It was unlikely there would be any useful conversation as Mary was apparently suffering from the effects of too much alcohol, so thankful for an excuse I left.

There was some mystery about this situation. Clearly Mary had a severe drink problem. But the question uppermost in my mind was why did she hate Helen so much?
CHAPTER FOUR

Patrick's eye infection was completely cleared. Laura had finished her course of treatment for the venereal disease and there was no evidence of the handsome Phil. Laura looked happy and relaxed as she let me in to the house, with no trace of the black eye or any other visible injury. Ryan was at home this time. He was a bright little four-year-old who chattered incessantly and Laura had requested some advice because he wasn't sleeping well.

The lounge seemed different. It soon became obvious why, as the spider aquarium had disappeared.

"What's happened to the spiders?" I said, hoping my relief was not too obvious.

"They've gone with Phil", said Laura " I've kicked him out." She told me that his sexual exploits were the last straw. He had caused the black eye and injured her many times before.

"I'm sick of covering up for him and listening to his excuses", she said "I should have listened to mum and dad they said he was no good." When asked if she was managing financially, it appeared income support was better than the money Phil used to supply.

"What did he do for work?" I said, but she said she never really knew. She thought he was some sort of electrician.

Ryan was waking several times during the night and coming into Laura's bed. He may have been missing Phil who wasn't his real dad but did play with him from time to time. Perhaps he was worried Laura may leave him as well. However, he seemed most eager to co-operate and interested in the suggested programme. The idea was to give him a long term reward for staying all night in his own bed. He would need a child's alarm clock set to ring at the time his mum wanted him to wake.

"You can make him a star chart" I explained "He can help you do it. There should be all the days of the week in boxes. Every night he stays in his bed until the bell rings next morning he can stick a blue star on his chart. When he has seven blue stars he gets a gold one and then you can buy him a present." Ryan listened with great interest to this cunning plan and then said.

"You don't need the alarm or the stars, I'll stay in my own bed and you can just buy me the present."

There was no answer to this logic. Ryan would obviously go far. Laura was laughing as I left her. It was lovely to see her so relaxed clearly happier without Phil and well supported by her parents.

Nearby, on the council estate, a young child about two years old was playing in the garden. The small boy was dressed only in under pants and in late November it was freezing cold. This house was a lucrative place for health visiting. It was officially rented by Lisa a single parent, but many of the others congregated there and it was always possible to see several at one go. I tried to grab the child by the hand but he slipped free. Attempts to scoop him up in my arms were totally unsuccessful as he slithered away, and it then became obvious that his entire body was coated in grease. I decided to go into the house for assistance but the toddler followed me in through the open kitchen door.

No one appeared to have missed him. The fridge was open and a margarine container minus lid could be seen on the floor. It did not need great powers of detection to discover the source of the grease. The television was blaring in the next room, so it was impossible to attract attention.

I went in and it was warm and foggy with smoke. There was Lisa, three of her friends and at least seven small children including the slippery one.

"What you been up to little devil?" "Where's your clothes? Oh come on and I'll clean yer up." Reluctantly she dragged herself away from the juicy gossip.

Lisa at twenty-eight was a large lady with blonde hair. She was normally quite cheerful despite her troubled life. Her dad had knocked her mum about and unfortunately Lisa seemed to gravitate towards the same type. She had four children all from different partners, but although she shouted and screamed at the older ones she was a loving, reasonably competent mother. Pregnancy was to her a delight. She nearly always kept her antenatal appointments and was depressed for a long time following her only miscarriage. There was little affection for her parents but she adored her grandmother, and when she wasn't with her friends it was always possible to catch her there.

"Is Dean in?" I said.

"No he's inside", said Lisa "He got caught nicking with his brother. He's in Wakefield and his brother's in Leeds. You'd think they'd keep them together. It's not right splitting up families before Christmas."

"How long has he got?" I said.

"Six months" was the reply "but he'll be out sooner for good behaviour."

The school nurse had found head lice in the two older children, but today when I checked Lisa's two younger ones they were clear. It was a good opportunity to discuss prevention with all the rest, but they had their own ideas about the cause of spread and weren't very receptive.

"It's that nitty Norah at the school" said one "she looks in one head and then passes it on with her hands to the next one, they don't get them from home."

"While you're here will you come and look at the kids' back bedroom?" said Lisa, "the walls are really damp and all the paper's peeling off." Health Visitors were not generally very successful in motivating the Council to do repairs but I agreed to inspect the room.

As we approached the back bedroom a man was coming out of the front one fastening up his trousers. The man was Phil and he was certainly not engaged in his electrician's occupation.

Promising to do my best with the Council I left the house. The doctor had asked me to discuss contraception with Lisa, but she had four healthy attractive children and wanted more, so it was highly unlikely she would be interested.

A delicious smell of baking wafted towards me as Susan opened her door. She was not at her classes today and had taken the opportunity to make some cakes as she had learnt how to read a simple recipe. There were some small currant buns, a cake which she said was a ginger one, and some scones. Sharon was happily licking out one of the bowls, and appeared to have got some of the mixture on Shane's tuft of hair whilst he was sitting watching the activity from his little chair.

"They look great" I said, "Have you got enough tins to put them all in?"

"It doesn't matter," she said "I'll leave then out until we've eaten them all," Most of the clutter was still covering the room, and it was impossible not to imagine how many assorted germs might contaminate the cakes before they were eaten. Explaining briefly about infection I offered to give Susan some spare containers to store the baking.

"I never did much baking when I was in children's homes and foster homes" she said "Mrs Garland's going to tell me how to make pies and things, soon I'll be able to read all the labels in the supermarket."

Before leaving she told me she was having some problems with her waterworks. It sounded like cystitis so it was necessary to send her urine to the lab.

"Have you got a clean jam jar or something?" I asked, but she took a blue plastic beaker from a hook and gave me her specimen in that. We covered it with a carrier bag so that it could be taken precariously back to the surgery in my car.

At school the nurse and all the teaching staff were still very worried about Helen. Social Services had visited again, but though they agreed there were problems, access was never refused, and continuing to monitor the situation was the best they could offer. The school nurse Jane, showed me Helen's height and weight chart. She was clearly failing to thrive and that could be ground for taking legal action together with emotional and physical neglect. We knew she was being neglected but we had to have proof.

"I looked at her sandwiches today", said Jane "I know we aren't really supposed to but I was curious to know what they gave her. There was one piece of dried bread with green mould on the edges and a few crisps. No wonder she is so thin."

"I'll make sure she gets a school dinner from now on" the headmaster said "but what I'd really like to know is what's happening to her at home?"

Jane wanted me to go with her to sort out a case of scabies. The two boys had been excluded from school until it had been treated but the mother said she couldn't manage to do it herself. On the way to the house it gave us a chance to have a further discussion about the best way to help Helen.

The two children lived near to the school and the mother seemed pleased to see us. We agreed with her that the method of treating scabies was rather complicated. She had provided clean clothes which were airing around a roaring coal fire and there was plenty of hot water. Jane started to explain to her that the scabies mite was a small insect which buried under the skin causing extreme itching but she didn't seem to be showing much interest.

"Now you've come I'll go to the shops" she said "I haven't been able to get out with them off school." Before we could protest she had shot out of the door, leaving us with two small boys to be bathed and painted. Sean and Philip didn't mind, they splashed happily in the hot water and came out to be dried without too much fuss. They were quite curious when we started to paint the solution all over their clean bodies but soon got fed up because it took so long. We managed to persuade them to stay still with the promise of a bag of sweets each, thoughtfully provided by Jane. At last the job was done. Every nook and cranny had been attacked with the insecticide. The boys were dressed in clean clothes inspecting their bags of goodies and thankfully mum appeared.

Though we had worn protective clothing our skin was itching on leaving the house. It was necessary to go the health centre and disinfect thoroughly. This gave us more chance to formulate a plan to solve the mystery of Helen, and we agreed to meet later to put it in to action.

Schizophrenia was the tentative diagnosis of Julie's condition. She had been well stabilised on medication and I looked forward to seeing her again now she had come home.

"Oh I'm glad you're here" she said "I want to start Katy on solids and I'm not sure of the best way to do it." She brought me a cup of tea whilst we chatted about weaning. She wanted to know everything in fine detail and insisting on making notes.

"There isn't any set routine about it", I said "Just introduce tastes, remember not to add salt or sugar and puree the food." Though she was still keen to write down a plan of actual meals, it was obvious that a lot of the stress had left her. Her dark hair had been professionally cut into a shining bob framing a small boned face with classic features. She was wearing a red plaid skirt and matching jumper, bearing little resemblance to the girl I had seen prior to her hospital admission.

"Have your parents seen Katy yet?" I asked.

"Yes, they came to the hospital, but they couldn't understand why I needed to be there, and kept saying there was no mental health problems in our family."

"Will you go to the Isle of Man in summer?" I said. "It's a great place for holidays."

"I don't think I could stand it for long," she said, "my sister and brother did so much better than me at school, and mum especially is always making digs."

"What about your father?" I said.

"Oh, he doesn't say much, but I know he's disappointed in me."

I pointed out that she had trained as a teacher, and by anyone's standards could be said to have done well, but she was not convinced by this. Perhaps because she was a middle child and the second girl she felt inferior.

"I wasn't a very good teacher" was her final remark on the subject "I don't seem to be very good at anything." Katy was lying on a rug on the floor chuckling and waving her rattle. Julie was interacting well with the baby and I told her.

"Yes but I'm only going through the motions" she said, "I have to make myself play with her."

"It'll come" I tried to reassure her "when you've been on the medication a bit longer you'll start to feel much better."

"I don't really like taking all these drugs" she said, "they can have all sorts of side effects." We discussed all the reasons why she must continue with the medication, and I tried to convince her that she had an illness just like a physical one, which would reoccur if she discontinued treatment. She did not seem persuaded and it left me feeling very uneasy when saying goodbye.

The plant which had received my unwanted drink certainly looked decidedly seedy but Zora was plump and thriving. She had gained a massive amount of weight though Fatima was not concerned by it. Breast fed babies rarely get fat, but she was being fed continuously, and Fatima had no household jobs to attend to, as there were so many people in the house. The atmosphere today was not so joyous as on my previous visit, and the reason soon became obvious.

"Where's Sohail today" I asked. Fatima had obviously understood this question because her large brown eyes filled up with tears.

"He went back to Iran three weeks ago" volunteered one of the students, "and we haven't heard from him since."

"There's persecution of those who are seen as a threat to the Islamic faith," said the other student.

"Aren't you Muslims then?" I said, but regretted my question immediately when they proceeded to answer it.

They belonged to a sect known as Bahai. The explanation of the faith was interesting, but perhaps because of their student status, they were evangelical in their efforts to persuade me about its desirability. Pleading lack of time, I managed to change the conversation to enquiries about the health of the mother and baby. I did manage to glean that the Bahai were totally against persecution on the grounds of religious conviction, and that they believed all faiths sharing a common belief in God should work together for the good of all.

"What is Sohail's job in Iran?" I asked.

"He's a very important government official in Tehran", they said, "He knows he can't stay in Iran much longer, now there is so much persecution under the new regime. He's hoping to sort things out and come to England."

It was obvious he owned property and possessions, and even if he was allowed to leave the country I wondered what would happen to his assets. The situation was probably similar to the plight of the Jews in Nazi Germany. Poor Fatima! She had known such joy on the birth of her daughter. Now she was faced with anxiety and possibly a long wait for news.

I gave Fatima a hug. The language barrier made this the only way to communicate my empathy, and hoped the next time we met there would be good news.

At six o'clock that evening Jane and I met at Helen's house to see if we could unravel the mystery of her neglect.

Alan answered the door. First impressions were of a tall man wearing a crumpled shirt stained with food and soiled brown trousers held up with braces. Jane was wearing her uniform so thankfully the door wasn't immediately shut.

"What do you want?" he said revealing chipped brown teeth.

"We've come with a machine to see if we can help Helen keep the bed dry" she said. "But we'll have to show you how it works and it's best if all the family see it. That's why we have come so late." This brought no response so it was time for salesmen tactics.

"It works in a lot of cases and hopefully Helen will respond well" I said, at the same time we both walked into the room carrying the parcel.

Mary was sitting in exactly the same chair as on my last visit. The room was warm but still cluttered with books, boxes and papers. Helen's brother and sister were on the settee. There was a low table which had the remains of a fish and chip meal. The television was on and the scene appeared quite normal, just as you would expect to find in countless other homes at that time in the evening. The only person missing was Helen.

"We have to measure up for the machine," I said. "Before we can show you how it works we'll have to see Helen's room."

"You can take it to our room" Alan said, "Helen's not well in bed, our room's just the same." Mary didn't say a word and the other two children continued watching the television.

The stairs led off the small square shaped hall. I went up first followed by Alan with Jane behind. A brown furry shape darted past me on the way up. I grabbed the bannister with shock hoping for some support, but it came away from the wall almost causing me to fall down the stairs.

"It's the room on the left " shouted Alan, but my eyes were drawn to the room on the right. This door was shut whilst the others were open. In front of it was a large packing case wedged up to the handle, so it could not be opened from inside.

"We'll really have to see Helen's' room" I said, "Is this it?" Alan didn't reply, nor did he offer to help Jane and me as we struggled to remove the heavy case from the front of the door.

The memory of what we saw in that room will never fade. It was like one of those propaganda leaflets from the NSPCC, which are designed to shock people. This was not a still photograph or an artist's picture, but a real living nightmare existence for a five year old girl.

The room was freezing cold. It was late November and there was no heating. The floor was almost bare with only the remains of some fawn linoleum. The window was covered so that no one could look in, with a piece of faded dirty material which may once have been a curtain. The walls had probably been distempered at one time, but were now covered with splashes of excreta. There was no furniture in the room. On the floor was a filthy mattress covered with two or three blankets that were threadbare and very dirty. A strong smell of ammonia gave out an acrid odour causing our eyes to sting.

Huddled against the corner of the wall with her arms wrapped around her bent knees was Helen. Whilst the family were sitting together eating their tea and watching television, this little child was locked nightly into her hell hole, unable even to use the toilet. With tears streaming down our faces we wanted to scoop Helen up and remove her from this dreadful place, but knew it was necessary to follow the correct procedures. We gave her a hug feeling her little thin arms wrapped round us. Jane gave her a sweet and we promised we would help her.

Downstairs the family was silent. Alan had already joined them, together with the brown furry object, which turned out to be a pet rabbit. I simply said, "You can expect an official visit from Social Services" not trusting myself to say anything else.

It was a dark and frosty night as we drove to the health centre, in order to telephone the emergency team at social services. One or two of the shops on the outskirts of town were already displaying Christmas lights and goods. People were eating, drinking, chatting and watching television as normal, unaware of Helen's plight. Why should they be blamed? Even the professional people, who were supposed to help, had failed for so long to ease the suffering of this little girl.

At home I lay soaking in a hot bath. Downstairs my two children were playing monopoly with their father arguing about some trivial point. They were a poignant reminder of the child I had just seen, but like the majority of their friends did not suffer such deprivation, being well fed, warm, secure and above all loved. At that moment I was profoundly grateful for my husband and family thankful that tonight the other child would be safe. But what about her future?
CHAPTER FIVE

Should I be worried about my daughter? I think she's eaten some of her cot mattress." This was the first call of the day on arrival at the health centre on Monday morning. Zoë was the fourth child of a farming couple who lived in the country five miles out of Saxford. She was a lively mischievous toddler aged 16 months, who had apparently caused more work for her parents than the other three children put together.

"What happened exactly?" I said.

"She was in her cot this morning and had woken up about 7 'clock. She wasn't crying, we could hear her playing, so I got the two eldest ready for school and then went up. She'd thrown all her toys out and was sitting in the cot with the mattress cover shredded. There was foam rubber in the cot and a hole in the mattress."

"How is she now?" I asked. "Has she eaten breakfast? Is she as lively as ever?"

"She's just her normal self. She's been out to feed the hens with me, but she hardly touched her breakfast and that's not like her."

I told her that I didn't know if she should worry but that I would ask the GP.

"Oh I've done that already" was the reply "They said if she's OK not to worry."

"Leave it with me" I said "I'll make further enquiries to be doubly sure."

Feeling slightly concerned because Zoë wasn't hungry, and because it was necessary to be absolutely certain, I phoned the nearest children's hospital. Tell her to call in sometime today to have the baby checked but there's no rush." They said.

When I phoned the farm her mum said she would go later in the afternoon. There was a lot to do, and grandma would be arriving mid afternoon to take care of the other children.

Just as I was about to leave to visit Susan, the hospital phoned.

"Thank goodness we've caught you" they said "We decided to ring the regional advice centre and they contacted Great Ormond Street. Your little girl must come in at once, can you contact her?"

"I hope so", I said but I wasn't very optimistic of contacting her by phone. She was always out on the farm so it would mean going there. "What's the main problem?" I asked.

"The foam will swell up inside her intestines and cause a large blockage. If we don't make her sick to get rid of it quickly, she may need massive surgery."

I phoned Zoë's mum but of course no one answered. It was a long way to the farm but it was a good job that I'd phoned for further advice, reinforcing the theory that if you don't know an answer to a problem don't guess.

As it was only two weeks before Christmas and Helen was in a children's home three miles past the farm, a change of plan was indicated. They were hoping to get Helen fostered before Christmas but I wanted to see her to take a card and present.

My newly cleaned car was soon splattered with mud, as I drove through the rut-covered lane towards the farm. Several stops were needed to open and close gates but thankfully it wasn't raining.

Zoë was in the yard chasing the hens. She had little red wellington boots on with postman Pat on the side and a bright red hat with a bobble. She looked the picture of health as she splashed in and out of the puddles. The children from the farm were rarely ill, probably because of all the fresh air and good food. It was important to convince Zoë's mum that she must attend hospital urgently without frightening her. She seemed convinced, and her husband agreed to care for Zoë's brother until grandma arrived. The two older children were at school.

A large drive led up to the assessment home. The area to the right and left was mainly grass, but the flower borders looked as if they had been well tended in summer. The parking area was at the rear of the stone built house. Here was a large lawn with a climbing frame, slide and swing. This home was intended for short stays, because a visiting tutor could only educate the children for about three hours a day. The children were usually aged five to eleven and many like Helen had been taken in on emergency placements.

Before I could find my way to the Matron's office, Helen spotted me. She was walking through the large hall towards the stairs. Two girls who were older were holding her hands. She looked so clean that it was hard to recognise her at first. Her hair, which had always looked brown, was actually strawberry blonde now it had been washed. She had two bunches tied with pink ribbons making her look like a little doll.

"Come and see my room" she said, and I promised to when I had asked permission.

Matron was pleased to see me, as she was anxious to know as much about Helen as possible. Helen's parents had agreed that she should be taken into care, the same evening Jane and I discovered the appalling state of her room. It had not been necessary to take out a special emergency place of safety order, and neither of her parents showed any inclination to challenge the social service's decision. More worrying still was the fact that they had only visited her once since her admission two weeks ago, and that was probably because the social worker took them in her car.

"She's settled in very well," Matron said. "We think there'll be a foster home available before Christmas. We're anxious to get some normality into her life as soon as possible."

It transpired that Helen was being petted by the older children especially the girls. Even though there were others of a similar age, her diminutive stature clearly was an advantage in this setting.

"It'll do her good to be spoilt for a while," I said. "She's probably never had so much attention."

"The only thing we do find slightly worrying" Matron remarked "is her attitude to the male staff. She's over familiar with them almost precocious."

"Well let's hope she does well with the new family", I said fervently hoping that my own suspicions were incorrect.

Helen proudly showed me her own room. It was actually a very ordinary bedroom, but to this child it must have seemed like paradise. Someone had supplied her with a pink brush, comb, and other girlie touches. The sheets and bedspread were clean. Two cuddly toys nestled in the bed. A carpet covered the floor and above all there was no smell. Helen had only wet the bed once on the first night of her stay, and was unlikely to do so again.

The two surrogate mothers kept picking her up and kissing her. She was much more fun than their dolls. I gave her a small wrapped gift and Christmas card, and she put it beside one she had received from Jane a few days before.

The bell rang for lunch so it was time to leave. She didn't seem upset saying goodbye. To the casual observer it would appear that she had totally integrated into this community. but the mystery of her neglect remained. It needed to be unravelled before the emotional and physical damage could start to be repaired. I hoped it would not be too late to prevent permanent scars.

Adam had a cold and he was due for his three month check so I called to see Claire as promised. Claire's mother opened the door. She lived in Saxford and though I had never met her she was often at the house, because I used to see her pushing Adam in his pram. She was a slim well groomed lady. Her dark hair was obviously well cut, showing no traces of grey, though she must have been well into her fifties. It was easy to see what Claire would look like when older as they were very alike. If Simon believed the saying "Look at your mother-in-law to see how your wife will turn out" he would not be disappointed.

"You must be the Health Visitor," she said. "Do come in Claire's just nappy changing. The poor little thing's full of cold." Grandad was in the lounge. I made sure he was Claire's dad before putting my foot in it. Grandparents no longer look like the storybook ones and it's easy to make embarrassing mistakes. He was recently retired from his job as a bank manager, and as Simon was not very practical, grandad did lots of DIY jobs for the young couple.

Claire came down with the baby and the grandparent's faces lit up at the sight of him. Both of them put their arms out ready to nurse their adored grandson. Grandad was the favoured one this time. He bounced Adam on his knee, and the baby chuckled trying to mouth sounds to respond to this man he was beginning to recognise.

"He doesn't seem to be too ill," I said. "Does he have more problems with breathing when you lay him down?" Claire agreed it was mainly in the night but said he was improving. All his three month developmental checks were satisfactory and he certainly didn't need any treatment for his cold. We talked about starting him on solid food in another month. Claire was sure he was teething and wanted me to inspect his mouth, but it's not usually possible to predict when the teeth will come.

Claire's brother and family had been for the weekend. . Adam had two cousins both girls aged seven and nine who loved playing mother with him. They lived in Devon so couldn't come often but it had been Adam's christening that weekend. Simon's parents came over for the day. They lived thirty miles away. They were very fond of Claire and besotted with Adam. Both sets of grandparents were sure he looked like their side of the family, and they were all right because he had inherited features from both parents.

Claire showed me his christening gown. It was cream silk with embroidered flowers and had been used for Adam's grandfather, mother and uncle. She gave me a piece of the christening cake in a box with my name on, which I was delighted to receive. The room was full of cards and presents to mark the happy occasion. They were planning to put the Christmas tree up the next weekend and all the family were looking forward to their first Christmas with the baby.

The antibiotics had cured Susan's infection and once again she was baking. This time the living/kitchen looked slightly less cluttered. She had made a batch of mince pies, which were covered with some tea cloths. The cloths didn't look very clean but at least it was a start. The teacher at the centre was showing Susan leaflets about food hygiene and reading them with her, and this was helping. I had also been able to show her ways to stimulate the children. She had started talking to them a lot more, and showing Sharon the simple board books which would later encourage early word recognition.

"I've brought Shane's first vaccination" I said "and also Sharon can have her measles one. They shouldn't be affected for Christmas."

"Thanks for bringing them to our house" she said. "They're hard to manage at the surgery together. I've told Ken he's got to have them when I go for myself."

"You're alright aren't you" I said. "No more trouble with your waterworks?"

She told me that she was fine but she wanted to get some family planning sorted out. This really pleased me because she had never come for advice before.

"I don't want any more kids now," she said. "I want to go to work and perhaps I'll learn typing. I don't mind going to the doctors now, but I was worried before I'd have to read and sign a form and I couldn't do it."

She was right, there was a form to sign for contraceptive services but no one had realised she couldn't read. Now she was soaking up ideas and information like a sponge because she was certainly not unintelligent. Unfortunately for poor Ken, she was getting slightly irritated with his apparent lack of motivation, and he was responding by spending more time in the garden shed. I was never quite sure what he did in there, but at least he didn't spend the little money they had on drink or gambling, and I had never seen him smoking.

Shane and Sharon didn't cry much when they were injected. Sharon toddled over and stuck her brother's dummy in his mouth. They were both well and Sharon had not had any more diarrhoea. Shane had a slight nappy rash. Now I was getting to know the family much better, it was easy to explain how thorough cleansing of the skin would help prevent this.

The large batch of mince pies was for the centre Christmas party which was the next day. Susan was looking forward to Christmas even though she had no extended family but was sorry that the centre would be closed.

"Has Ken got any family?" I asked her.

"He has, in Saxford, but we never see them" she replied.

I agreed to sample a mince pie and have a cup of tea. The people at the centre would be eating them, not knowing anything about the kitchen where they had been prepared, and they certainly looked appetising. The cup of tea was served in a plastic beaker, and as there appeared to be only one blue beaker it was probably the same one that had been used for the specimen. Trying not to think too much about the finer points of the preparation procedure, I ate the pie and drank the tea, pronouncing them both, quite truthfully, delicious.

Phil was again at Lisa's when I popped in to take her some toys for the children. Some of my families had donated them for Christmas. He was sitting in the lounge surrounded by young women who were lapping up his every word. There wasn't the slightest trace of embarrassment on seeing me, but he obviously didn't want to waste too much charm on a mere Health Visitor, when there was such a receptive audience of admirers. Perhaps Lisa's next baby would have the handsome features of Phil was my immediate thought, swiftly followed by a most uncharitable one connected with the likely fate of his male spider when left with the female.

The optician's shop was empty when I called in to collect my daughter's glasses. Much to my surprise Laura was behind the desk. It seemed she was working there on a temporary contract to cover maternity leave.

"Mum and dad are quite happy to have the children," she said. "I'm going to see if I can get back in at teacher trainer college, I'd done eighteen months when I got pregnant with Ryan."

She looked radiant. Though she had been happy on my last visit, today she was positively glowing and the reason soon became obvious.

"Mum's sister died" she said "We weren't actually all that close because she's always lived abroad, but she's left me £20,000 enough to buy my own house."

It was wonderful to hear this news, Laura was due for a bit of happiness and I wished her well.

The hoot of a four wheel drive vehicle startled me whilst walking back to my car. I was lost in thought musing on the sudden turn in Laura's fortunes.

"We're just back from the children's hospital," said Zoë's mum. "There was a reception committee to meet us when we arrived in casualty."

"Is Zoë alright now?" I said, but one glance at Zoë wriggling against the restraints of her car seat harness, made this question unnecessary.

"She's fine. They gave her a large drink of tea in a bottle. She loves tea and drank it all, but it had something to make her sick, and all these great big pieces of foam came up."

She had been kept at the hospital for a while and then discharged. It didn't bear thinking about what might have been her fate if the treatment hadn't been so prompt. With a cheery wave, mother and daughter drove back towards the farm, where no doubt Zoë would have another mishap before very long.

All the furniture from the lounge was pushed to one side of the room in Julie's house. The curtains had been taken down, and the contents of the bookshelves and cupboards were piled into cardboard boxes. There was no evidence of any Christmas decorations and it appeared that spring-cleaning was in progress.

"You look like you're doing a thoroughly good job," I said, as Julie looking very agitated let me into the house.

"I started at six o'clock this morning when Katy woke up" she said. "David's mother and father phoned to say they're coming from Birmingham to spend Christmas with us. I'll never get everything done."

"They're probably coming up to see you and Katy" I tried to reassure her, "I expect they will help, and your house never looks very untidy."

The psychiatric nurse who made regular home calls, had told me she had increased Julie's medication to try and make her calmer, but it was probably the impending visit of the in-laws which had made things worse. Katy was obviously just waking up so I said to Julie, "Look I'm dying for a cup of tea, let me help you put the furniture back now the carpets are clean and then we can chat."

She let me help her with the large items but David would probably have to sort the rest out when he came in from work. Fortunately he was an extremely patient man who never seemed to lose his temper, and appeared on the surface to be coping well.

Julie was finally persuaded to put the kettle, on and I went upstairs to fetch Katy out of her cot. At five months she was quite happy to be nursed by any person who looked friendly. She held her arms round my neck and pulled at my hair. She was starting to vocalise quite tunefully playing with rattles and easy to handle toys.

Once again Julie wanted to talk about feeding, going over everything in minute detail. She insisted on writing it all down, wanting to know the exact amounts of food to give and what time it should be given. I mentioned how well Katy looked, and that she was doing everything right for her age. Julie then wanted to know how long each day she should play with her and when was the best time.

"It doesn't matter when it is," I said, "Just talk to her while you're working and play with her at different times."

"But I won't fit it all in" she said. "I must have a plan. There's all the food to do for Christmas. I don't know what meals to make or anything."

The only thing to do was to make a plan of the meals for the two days her in-laws would be staying, and decide what could be put into the freezer in advance. This seemed to mollify her slightly and she said she wanted to tell me something.

"When I was driving over the bridge yesterday, a voice told me to crash the car into it and that would sort everything out."

"But you didn't do it" I said. "David would be devastated without you and Katy."

"He might miss Katy" she replied "but he'd be better off without me."

After this disturbing information her mood abruptly changed. She started telling me all about the Catholic Church she went to, and how she'd got involved in the young wives' group.

"I'm going to do them some baking for the old people's club but I've promised to do that this week."

"I'm sure they'll understand if you tell them you've got visitors coming" I said, "you haven't been well and it's much better not to try to do too much."

Whether she was persuaded that this would be the logical thing to do I don't know, but her next topic of conversation was even more worrying.

"I've been to the library and done some reading about those drugs I'm taking. They put on weight and can cause all sort of side effects."

"Most drugs have some side effects" I said "but you have to weigh it up against the advantages, and you do really need to take them or you'll be back in hospital."

"Well I'm not sure about them all" she said, "There's these natural herbs you can take which are very effective and don't have all the problems."

"Please, Julie, don't stop taking them without telling the nurse or the psychiatrist" I implored her, but as I left the house was forced to admit that the visit had left me feeling uneasy.
CHAPTER SIX

My alarm rang as usual at seven o'clock but there was something different. Because I was so sleepy it took me a while to realise that everything outside was strangely quiet. There were none of the usual sounds to be heard, and especially noticeable was the absence of car engines. Perhaps it wasn't really morning. I would be able to snuggle under the duvet and go back to sleep. Another glance at the alarm clock shattered this wistful contemplation. Then the silence was broken by a metallic scraping sound, which could mean only one thing.

The view from our bedroom window was delightful. The crisp white snow had covered the entire landscape. There was no sign of any road markings and all the neighbour's gardens and trees were covered in white giving almost total uniformity. Here and there the carpet was disturbed by the footmarks of the early risers like the postman and milkman, but there was no hint of greyness to spoil the overall sparkling effect.

Of course it was Monday morning, bringing the realisation that the wintry scene which had taken everyone including the forecasters by surprise, could not simply be admired from the warmth of our cosy bedroom. My white car left in the drive looked like an enormous snow balloon. It would need a lot of attention before venturing out on the road.

We all rushed through breakfast. The children went out early to play in the snow before walking to school. It was early February and the first proper snow that winter. Whilst I tidied up in the kitchen, I could hear my husband digging and scraping like so many of our neighbours. It was good to know that when it was time for me to go to work, my car would be free from snow and ice with the engine warmed and ticking over. I decided that we would have something special for tea, because I didn't always show how much I appreciated all his help.

The drive to the health centre normally took about twenty minutes, but today due to everyone starting out later it was much longer. There was one nasty moment at a mini roundabout situated on the top of a hill. I thought I would have to stop with disastrous consequences, but the car in front managed to get going and all was well. The longer journey than usual gave me time to plan for the day. There was no baby clinic. The visit to one of the farms would have to be cancelled. Perhaps I could just stay in the office catching up with clerical work and answering phone enquiries.

The phone was ringing as I walked into the building. It appeared no one else had arrived so I rushed to answer it. Suddenly all the days plans were abandoned. The phone call was from one of the doctors at the surgery and brought the news which every Health Visitor dreads. Claire and Simon's baby son Adam aged four months had been found dead in his cot.

The short drive to the house was done without even noticing the condition of the roads. Indeed I can hardly remember the route taken. All I could think was why had this happened to Claire and Simon of all people, and pray that I would be able to do and say the right things. My last visit had been following Adam's christening and sharing the family's joy. Now the small child, who had been the culmination of their love for each other, was there no longer.

Claire's parent's red car was in the drive next to her blue estate car. Simon's car would still be in the garage. Nothing would ever be the same again for this family. I dreaded the visit, feeling an overwhelming inadequacy in my ability to be of any help.

Claire's mother answered the door. She was barely recognisable as the fashionable attractive woman I had met a mere six weeks before. Probably she had been woken up with the news. She was wearing a jogging suit and her face was devoid of her normal immaculate make-up. Her eyes showed recent weeping and she appeared to have shrunk in statue.

"Why did it happen?" was her question. It was a question which would be asked frequently and one to which there would be no satisfactory answer.

"I'm so sorry" I said, and followed her into the lounge.

Claire was sitting at one side of the settee and Simon at the other. Normally they were a couple who were very close physically, but Simon was not able to give this comfort at the moment. I went to him and squeezed his hand, putting my arms around Claire and giving her a hug. Tears were coursing down my cheeks. Her body was cold, rigid and unresponsive. The only thing she wanted was not in my power to give, and there was nothing to be said or done which would take away the dreadful grief of losing her child.

"Tell me about what happened" I said, knowing it would be better for her to talk about recent events.

"It was my fault," she said. "I didn't go in to see him when I got up to go to the toilet. I usually do and last night I didn't."

"No" I said, "It wasn't your fault. When babies die of cot death, it can't be prevented. Babies have even died whilst being nursed."

"I shouldn't have taken him to my mum's house" she said. "He had a slight cold and I should have kept him in."

"Was he feeding well?" I said, and she told me he was. "Well, you did right to do all the normal things. He obviously wasn't very ill."

Claire then went on to tell me that she had breast fed Adam and put him to bed at the usual time. He was a bit snuffly but otherwise the same as usual.

"Why couldn't we stop it happening?" Simon said.

"They don't know the answer to this" I replied. "But they are doing research all the time to try and find the cause. What is known is that when it is a true cot death it can't be prevented, and the parents are not to blame."

"Adam had blood round his mouth when I found him" Claire said "and his skin was all blotchy."

I explained that these things would occur after the death and were not the cause. It was then necessary to tell the parents that there would be a post mortem to confirm that Adam was healthy before he died, and also to help with research to prevent further deaths.

Claire's father was keeping himself occupied making endless cups of tea and washing and tidying up things already done.

"There's two police officers to see you," he said to his daughter.

"We can't see them now," Simon said. "Why have they come anyway?"

Wishing that I had told them before, though there had never been the right moment, it was important to try to explain why the police needed to visit. Unfortunately it is an inescapable fact that some babies are killed by their parents, and the police must investigate all causes of sudden infant death. Without mentioning this, I tried to convey the fact that the police were only carrying our mandatory investigations.

The two police CID officers were one male and one female. They asked their questions with tact and sympathy and were obviously experienced. Claire and Simon had to recount the last twenty-four hours again and it was just as distressing. Adam had been cold when Claire went into his room at 7.30am. She picked him up and screamed for Simon to come. They phoned 999 and the paramedics took the body to the hospital. Claire had wanted to go with him but Simon persuaded her not too.

"Can we see your baby's room?" said the male officer.

Claire was weeping and Simon was sitting in a frozen position, his eyes staring without seeing.

"Shall I come up with you?" I said to Claire. "They do need to see it."

The pram was in the hall as we walked past. A black and white toy panda was sitting half way up the stairs. The nursery was decorated in yellow and white. Characters from Winnie the Pooh were painted around the walls. The nursery furniture was in pinewood, and there was a large toy box with Adam written on the top and sides. The colourful mobile of Winnie the Pooh's animal friends chimed as we opened the bedroom door. It was hung above the pine cot where Adam had been found. The little white flannel sheet and lemon cot blankets were pulled back, and I could hardly bear to look at the place where he had been.

The lady police officer took the bedding and placed it in a blue plastic bag. It seemed such a shocking thing to do and Claire reached out to stop them.

"They have to do it," I said. "They'll bring them back."

When the police had left, Simon asked where the baby was. I explained that he was in the chapel of rest at the hospital and they could go to see him.

"You can take him some clothes and change him" I said and offered to go with them

Before leaving, we talked about the practical arrangements which would need to be made. Claire's father wanted to help, probably keeping active would help him to cope. The front of Claire's dressing gown was wet with milk, a poignant reminder of the infant who had so recently suckled at her breast. She would probably need some advice to dry up her supply but the doctor would be calling later to see them. Simon agreed that I should ask the vicar to visit, as they knew him fairly well. He had only just performed the baptism and would now have to conduct the funeral service.

It was almost midday and Simon's parents were just arriving. They looked grey with shock and grief as I passed them in the hall. Both sets of grandparents had lost their adorable grandson and would need to support their own children whilst grieving themselves.

Simon did not return to his work at the dental surgery before the funeral. The couple needed each other and it would have been difficult for him facing all his patients.

There were no other cars in the drive when I called three days later.

"I'm very worried about Claire" Simon said, "She's just sitting in the chair all day. She won't talk to me about how she feels and won't let me get close."

"What about you?" I asked.

"Everyone's concerned about Claire but I loved Adam too. It's like people are making me feel responsible."

Claire admitted that she had no energy or desire to do anything. She was sitting in a chair, her arms held out as if holding a baby. When asked if she was sleeping she said.

"I can't get off to sleep for ages. When I finally do there's the most horrific dreams, and then I wake up thinking Adam's still there and I can't bear it."

I asked her to show me some photos of Adam. We looked at the most recent ones following his christening. She showed me the lock of hair she had taken from him at the hospital chapel. It was in the album with his bracelet tag from the birth and the first photos.

"He had just cut his first tooth" she said, "It will be right through by now."

"I keep saying we should pack all the baby things away," Simon said. "It's no use to keep talking about things over and over again. It won't bring him back and it only makes us more upset."

We talked about the grandparents and how they were feeling. Simon said his parents had gone home following a blazing row. His father had suggested that there must be some weakness in Claire's family, because there was certainly nothing like that on their side.

"People react so differently," I said. "It was probably your dad's way of grieving. He just needs to find a rational explanation, but you and Claire need to try and talk about your feelings and not bottle them up. There is no right way to cope with this."

"She won't let me touch her," Simon said "When I try to get close, she pushes me away."

"I'm not ready for it" Claire said. "I don't think I could ever make love again. It only causes hurt."

I tried to explain that just holding hands or lying close together could be a start. Adam would never be replaced, nor should they try to do so. His memory would always be precious and the pain would never really go away. For Claire, the best thing was talking about Adam, looking at his photos, and handling his clothes. She should not stop doing this or make any changes until she felt the time was right.

The funeral was to be in four days time, exactly a week after the death. We talked about the practical arrangements. Claire's tears were flowing freely. Simon went and sat on the arm of her chair. As I left the house he had his arms around her, and she did not push him away.

The old church was about four miles from the town centre, in a small village surrounded by open country. It was a seventeenth century church with a large burial ground and dominated the landscape. The snow had disappeared quickly and the day was crisp and cold with blue sky and bright sunshine. Although I was fifteen minutes early for the service, the church was already half full. The doctor who had been called to the house on the morning of Adam's death arrived at the same time as me, and we sat together in a pew towards the rear of the church. It was Monday morning. There had been a wedding at the church the previous Saturday. All the wedding flowers had been removed, but as we entered the churchyard small traces of confetti could be seen nestling in the grey flagstones.

There was a large vase of white lilies at the front of the church. A lot of the staff from the dental surgery were there. Some people sitting at the front were probably close relatives, but the immediate family had not yet arrived. The organ was playing softly and the well known hymns gave out a melodious sound. No one was talking as they often do before the service. Some were already crying. The feeling of mourning and grief was so intense it was almost tangible. In the solitude I tried to pray that Simon and Claire would be given strength to cope with today, and find some comfort from the prayers and service to help them in the days to come. My thoughts kept returning to the tiny wax like figure seen in the hospital mortuary, and I felt profound sorrow for Claire and Simon on the tragic loss of their little boy.

Simon's mother and father arrived, but neither of their sons was with them. They looked old and grey walking up the aisle supporting each other. They sat on the row next to the front. Claire walked up the aisle. She was between her mother and father. She was wearing a black leather coat and appeared outwardly composed. Her face had a mask like expression and she was staring forward with unfocussed eyes. It appeared as if she was just playing a part, going through the motions without registering the surroundings.

There was a movement at the back of the church and we all stood up. The vicar walked down the aisle in his black cassock and white surplice. He was a lovely man who had been in the parish for three years. It was his first funeral for a child. He had three young children of his own. The youngest was about Adam's age. It must have been very painful for both him and his wife. I noticed she was there, thinking how brave it was of her to come, but she attended the same mother and toddler group where Claire had taken Adam, and there were other young mums who had come to show their support.

Simon and his brother followed carrying the tiny white coffin. It must have been so light in weight but such a difficult thing for them to do. There was only a single wreath on the coffin from Adam's parents. It was white and yellow and in the shape of a teddy. They had requested no more flowers as they wanted donations to be sent to the Foundation for the Study of Infant deaths. People were sobbing openly at the arrival of the coffin. Though I had wept many times in the last week it was impossible to staunch the flow of my own tears.

The congregation stood to sing a hymn:

"All things bright and beautiful.

All creatures great and small.

All things wise and wonderful.

The Lord God made them all."

The vicar spoke well, but probably their acute grief would have prevented the close relatives from taking in much of his address. He recalled Adam's short life and spoke about the milestones he had reached. He talked about the baby's lovely smile and happy disposition, even mentioning the first tooth he had just cut. The text used was from Psalm 30 and was "weeping may remain for a night, but joy comes in the morning." Though the night would indeed be very long for Claire and Simon, there had to be some light at the end of their darkness.

There was little opportunity to speak to the parents after the funeral service. Most of the congregation followed the relatives into the church cemetery. A tiny grave had been dug for the baby's small white coffin. It was lowered into the hole, and the vicar committed the body to the earth with a short prayer. Claire and Simon threw some soil in first, followed by the grandparents. The yellow and white teddy bear wreath was placed on the mound of earth beside the grave and I walked away from the churchyard feeling profoundly sad.
CHAPTER SEVEN

Laura looked even happier than when I had last seen her. Ryan was now at school and sleeping well so she would certainly be more rested.

"You look great," I said. "Are you still working?"

"No, the temporary job has finished but I've got into the teacher training college and I start in September. Patrick's got a place in the crêche so there's no problems'"

We talked about Patrick's hearing test which would be due soon, and also discussed home safety issues now he was becoming more mobile. He was already rolling all round the room but Laura had a large safe fireguard. The main problem was the small toys that Ryan played with. There were lots of small pieces which Patrick could easily swallow.

"I keep telling Richard to be careful when he gets him things," she said. "But to be honest I think he likes playing with them himself and he's so good to the children."

Richard, it turned out, was Laura's new boyfriend. As far as I could gather there were no complications as he was single. More important still, she said he was very kind and not violent in any way.

"Do your mum and dad like him?" I asked.

"Yes, they seem to get on really well with him. He's a policeman and dad's ever so interested listening to some of the cases he goes to."

She told me that of course he didn't identify people, but often told them amusing incidents, and how they were trying to solve various crimes.

"Have you met his family too?" I said.

"No, I haven't yet. He says his parents are elderly and they don't really like children. He's got a sister but they don't get on."

Perhaps she picked up some vibes from me, though her choice of boyfriends was not really my concern unless it adversely affected her children.

"Don't worry, I'm not rushing into anything, but I do think there may be some future this time."

Hoping she was right and that her policeman would make her happy, I made my way to the surgery.

The next month we were all moving to a new purpose built surgery half a mile down the road. There was an office for me and as I had been consulted about the design it promised to be a Health Visitor's dream. Certainly being based at the surgery would be a distinct advantage in terms of liaison with the other staff and clinical practice. There were lots of new things I wanted to do which were currently not possible. It was also reassuring to know that the doctors wanted their Health Visitor on site, and a positive sign that they were beginning to understand my role.

There was a message for me to phone the children's' home about Helen, which rather surprised me because she was supposed to be in foster care. Also Susan's cervical smear test had shown two positive results and I would have to visit her to explain what would happen next.

It turned out that Helen had been placed in an ideal foster home. There were two other children, a boy of around eight and a girl of about two. Unfortunately she was over affectionate towards the children's father, sitting on his knee and stroking him in an adult way. More worrying still for the family, she had tried to engage the older boy in inappropriate sexual play using explicit language. Naturally, the family was worried about their other children, and poor Helen had to return to the home. This was not altogether surprising as there had been signs that she had been exposed to sexual contact. It certainly would explain the reason why her father had not contested the decision to remove her from home. Mary was now drinking even more and too ill to care, but Alan never visited Helen or made any move to be involved in decisions. Probably the truth may never come out, but Helen would need a lot of psychiatric help and above all a suitable foster home, if she were ever going to lead a normal life.

Just before reaching Susan's house I almost ran over a small plump figure with black hair. Braking abruptly it took me a short while to realise that it was Fatima waving me to stop. This was the end of the council estate which was really rough. There was no definite policy, but it did seem as if all the most hard to place families ended up there. It was certainly Fatima and she was without her baby, which was even more unusual. What on earth was she doing there?

"My man home" she said. "New house looky here."

Totally confused, but admiring her attempt to speak English, I followed her to one of the houses. Fortunately one of the relatives was there and was able to give me an explanation. Sohail had finally been allowed to leave Iran after several weeks of very scanty contact. However, all their possessions were confiscated. He was not allowed to sell anything or bring any money out of the country. Sohail's job had been an important one and they had enjoyed a good standard of living. Now they were together which was cause to rejoice, but they were virtually penniless. The temporary accommodation was severely overcrowded so they had applied for a council house. To give them credit, the council had given the family a house at once, but I had grave misgivings about the location. This couple would most likely be the only foreigners on the estate, and might well be subject to racial abuse. Due to their limited English they could have no idea of the type of neighbourhood they were moving into. It would be a real culture shock to them, making it very difficult for them to integrate as Zora grew up. The rules of tenancy would have allowed them to refuse two properties until they found an acceptable one, but they were so delighted to have a home that it was a problem to know whether or not to tell them this.

Zora was with her grandparents, while Sohail, Fatima and two of the students cleaned out the house. One of the neighbours was shouting obscenities to a passing man. The students had obviously heard it but Sohail and Fatima were blissfully unaware. If they had looked around, seen the many uncontrolled dogs roaming the estate and noticed the overgrown gardens piled with junk, they may have been concerned. The truth is they had a house, which was their primary concern. It was early March. The weather was cold, blustery and grey, so there was little opportunity to take in the surroundings.

I bade them goodbye, promising to visit when they were settled and wondering about contacting the council. Health Visitors didn't have very much influence in housing matters, but it did seem that these circumstances were special. There was a lovely council estate at the other side of the school, but there may not be any empty properties. I decided to give the problem some thought and do my very best for the family.

It wasn't the day for Susan's class and I was pleased that she was in. There was no smell of baking today, and the house was starting to look much more organised. Susan was reading a book to Sharon, a task that would have been impossible a few months ago. It was a delight to see her doing something most of us take for granted.

Shane was now sitting alone. He was a happy baby with a voracious appetite. Sharon, at eighteen months, was a much smaller build. She had learnt not to go too near to her brother because he grabbed her hair and pinched. Sharon was due for her assessment. Susan looked at what she was expected to do and we worked through it together. She wanted to know how to plot the percentiles on the weight chart and easily understood how to do it. She seemed to be getting a little impatient with Ken because he lacked motivation to get a job, and was apparently content to stay on welfare benefits. We talked about how they had met and the fact that Ken didn't drink or gamble. I suspected that Susan, being so much younger, had a much greater capacity for change than Ken, and hoped that they could come to some compromise, as I felt rather sorry for him.

"We've got the result of your second smear test," I said. "Unfortunately it showed some cells that weren't normal."

"What do I have to do about it?" asked Susan.

"They want you to go into hospital for the day next week. You'll be given a small anaesthetic and they can have a good look. Will Ken be alright with the children?"

"I'll take Sharon to my friend's," she said. "It's easier if he only looks after one."

She didn't seem unduly curious about what would happen next, which rather surprised me. Of course it would depend on the gynaecologist's findings next week, but most people would have been extremely concerned by this stage. I hoped for her sake it was not too serious, and that at the worse it would only be necessary to do a cone biopsy. This would mean taking away a small section of the neck of the uterus.

It was now a month since Adam's death. Simon had of course returned to work but often came home for his lunch. Outwardly Claire was looking better. She smiled as she opened the door, but to people who knew her well it was obvious she was still grieving.

Adam's pram and chair had been cleared away but I was pleased to see all his photos in their usual place. The results of the post mortem examination had come but as it was better to go through them with both parents, I hoped Simon would come home today for lunch.

"Are you sleeping any better?" I asked.

"Yes, I think so. At least I don't wake so often."

"But what's the sleep like?" I asked.

"I dream a lot, really frightening dreams and walk up exhausted in the morning no matter how long I sleep. Sometimes when I wake up I can hear Adam cry and it's so real."

"That's very normal," I reassured her. "Most parents and mothers especially, say exactly the same thing."

She told me that Simon had been talking about whether they should try for another baby. It would mean infertility treatment again and Claire did not think she could face it.

"No-one can advise you about that" I said. "But it must be a joint decision and not something you rush into."

Claire said that she was never the same from one day to the next, some days she felt a bit better and the next day she was worse.

"Are you and Simon able to talk about Adam's death and how you feel?" I asked.

She said that Simon had made an effort because his way of coping was not to talk about things.

"We've been out walking in the country the last two weekends and can talk then."

I was really pleased to hear this. There is good evidence that physical activity helps, and getting out of the house would also be an advantage.

Just then Simon came in. He gave Claire a kiss and a hug with real warmth and she did not freeze. We talked about the problems he must have had seeing all his patients. He admitted it had been really difficult particularly the ones who were embarrassed themselves.

"I used to talk about Adam to them" he said. "I miss my son for all the things we didn't do together, and would have if he had lived."

We went through the findings of the post mortem. Simon was a dentist so he was used to the medical jargon. Because a pathologist who does not know the deceased child writes the reports, they tend to look very clinical and can cause parents great distress. Simon and Claire wept as we went through it, but they wanted to keep a copy for themselves. The official cause of death was given as sudden infant death syndrome and this must have been some comfort to them

"If we ever did have another baby, how could we be sure it wouldn't happen again?" Simon asked.

"It's not possible to say definitely," I had to admit, "but there is no real evidence of any genetic connection,"

I then went on to explain that should they decide to have another baby there was an intensive monitoring programme they could be put on. They would have a lot more visits from medical staff and any changes in the baby would be carefully noted on a daily basis.

It was time for me to leave. Simon would have to eat his lunch quickly and it was my afternoon for baby clinic, but I resolved to visit them as often as was needed.

My mouth was full with a ham sandwich when the telephone rang. Having only ten minutes before clinic, it was tempting to let the answerphone take it, but I didn't.

The voice on the other end was slurred. I thought at first it was Mary, because she was certainly drinking more heavily since Helen had been taken away. She had never phoned before so it was most unlikely. But who could it be?

"Can you come? I've taken all my tablets. I don't know what to do" was the gist of it. Then my heart sank as I realised it was Julie.

"Are you at home?" I asked. But she had obviously dropped the phone and further information would not be forthcoming.

This left me with a dilemma, but no time to think rationally about the pros and cons. Julie was very unpredictable. She could have taken a lot of tablets or very few. I assumed she was at home, but didn't know if Katy was with her. Should I call the ambulance now with very little information, or drive straight to the house which would take me only five minutes? I decided on the latter course of action. Clinic was due to be opened, so it was necessary to leave the keys with reception at the health centre. They could phone the ever dependable Marjorie. She would open up the building and hold the fort until I arrived.

Leaping into the car and leaving my uneaten lunch on the desk, I made the short journey to Julie's house. It was only then that I realised the door would probably be locked. Julie was unlikely to be able to let me in and David would probably be miles away, as he drove quite long distances in the course of his working day. The police could force their way in, but this would waste valuable time.

The doors were both locked, but there was a small kitchen window open. Ringing the bell and banging on the door brought no response, so I decided to try and get in via the window. There was a plastic dustbin which I could climb on, but it was not very safe. After removing my shoes it was possible to stand very precariously on the domed lid. With careful manoeuvering I managed to get my hand through the small open window, and push the handle of the large window so that it opened. Fortunately the access route was not too cluttered making it fairly easy to climb through into the kitchen.

Katy was crying. From the direction of the sound she was upstairs in her cot. At almost eight months her crying was very loud indeed, but she would be safe, if unhappy, and her mother was my first priority.

There was no sign of Julie downstairs. The kitchen didn't show any evidence of recent food preparation and the lounge looked tidy, but the curtains were all drawn.

The first thing I saw when entering the bedroom was a pool of blood on the cream carpet. At first glance it looked to be a massive amount and I feared the worst. Julie was lying on the bed. She was on her back and she was deathly white. Both her wrists had been cut the left one more severely, but it was dripping rather than gushing onto the carpet. Grabbing two pillowcases from the bed I wrapped them tightly round her wrists and placed them above her head. I didn't undo the makeshift dressings but surmised the cuts were superficial, because the bleeding almost stopped. Julie was not unconscious but it was impossible to glean any information from her. It was obvious by the empty bottles beside the bed, which tablets she had taken.

Katy had stopped screaming but only briefly and now she continued with renewed vigour. There was a phone by the bed and I dialled 999 to call for an ambulance. It was impossible for me to do anything with Julie except to put her on her side to avoid choking. I was certainly not going to manage to keep her awake, and poor Katy needed some help.

The ginger curls were soaked with Katy's tears. Her face was bright red and she was chewing hard on her little fist. Her arms clutched tightly around my neck when I lifted her out of the cot. She clung to me, her body shaking with sobs. She still had her nightclothes on and may well have been in the bedroom for several hours. By the time she had calmed down a little, the ambulance had arrived.

The paramedics put Julie onto a stretcher and carried her to the ambulance. The bleeding had practically stopped. It was as I had suspected and the cuts were not too serious. The paramedics took the empty medicine bottles with them. Apart from the history of her psychiatric illness there was nothing else I could tell them. I gave them information about David but said I would try to contact him. Katy would have to stay with me until he could be traced, as she was already very distressed.

The baby would not take her arms from around my neck to allow me to put her in the high chair. She looked as if she may be hungry, and I found her a rusk which she crammed into her mouth smearing some of it on the back of my neck. There were two bottles of ready made baby milk in the fridge, and I took one out to warm it. Katy spied it. She grabbed a bottle and sucked it hungrily, not minding that it was very cold.

In the nursery she allowed me to sit her on the floor, so I was able to dress her in a jogging suit and change her very wet nappy. The car seat was in Julie's car in the garage so I put it in mine. The dustbin had disappeared from the back garden and unfortunately my shoes as well. Whilst I had been in the house the bin men were in the area. Julie's dustbin was awaiting collection at the front of the house. It was empty, and I didn't need too many guesses to know where my shoes had gone.

We set off for clinic with some more rusks and the other bottle. David was working about sixty miles away but his office promised to get him to phone me as soon as they could.

There were about ten mothers and babies in clinic. The knew me better now and quite a few were actually eager to ask for advice. Katy had fallen asleep in the car on the short journey, so I carried her into the clinic in the car seat, knowing she would be well cared for by Marjorie. The ever dependable Marjorie brought me a welcome cup of tea and a pair of old shoes which she kept in her car for driving. They were a little on the large size but much better than bare feet.

We had put a suggestion box in the waiting area in order to improve the clinic and try to meet the client's needs. Marjorie encouraged them to use it. As a result we had made some changes which improved the service. The most important one was that I now sat in another room away from the waiting area. This allowed for much more privacy and the mothers had confidence to ask questions that they might have been embarrassed to ask in an open room.

The clinic was fairly uneventful. Katy woke up but she appeared quite happy watching all the activity in the clinic. She drank another bottle of milk and ate two more rusks. David phoned in the middle of the afternoon. We agreed he should go straight to the hospital and I would take Katy home, waiting at his house until he came.

Just as we were thinking about organising the mothers to pack away the toys, a lady arrived with a little boy who was nearly four. There were two older children in the family and I had not met them. The little boy was carrying three traffic light cones which he grasped tightly.

"Can I ask you about our Steven?" she said. "He's not like his brothers and I'm worried about him".

She told me that Steven had seemed fairly normal when he was a baby. The only thing they had noticed different about him was he was obsessed with routine, and this was still the same if not worse.

"We have to line all his cars up in exactly the same order" she said "when he goes up to bed everything must be done in the same way. If we try to bath him at another time, or alter the story telling or teeth cleaning he goes mad".

When I asked her about how he played with his toys, she told me he put everything in a rigid order but didn't play appropriately with them. The traffic cones were a new thing. He insisted on picking them up from the road when he saw any. He carried some around all day and even would not go to bed without them. I tried gently to remove a cone from his grasp, but he screamed loudly. It was also difficult to maintain any eye contact with him when talking. He could speak quite well, but his mother said he didn't always appear to give a sensible answer to questions. He was also fascinated by television adverts, and could repeat them word for word.

It seemed certain to me that Steven was autistic. He had never been to play group or nursery because his mother knew there would be problems. At first she thought his behaviour was just a variant of the normal. She had plenty of experience with two older children, but now that the situation was getting worse she was anxious to get help. I didn't mention autism because the psychologist would make the diagnosis, but I agreed to refer Steven for a full assessment as soon as possible. She seemed relieved to be getting some help, which was not surprising. It must have been very difficult for all the family coping with him.

David didn't arrive home until seven o'clock. He was very apologetic but it was six when he got back to Saxford and then he had been to the hospital to see his wife. Fortunately my parents were always around for my children, until their father or myself arrived home. Katy had eaten her tea and was nearly asleep drinking her bedtime bottle when David came in.

There was good news about Julie. Her stomach had been washed out and she was now conscious. Because of her unstable mental condition they wanted to keep her in the psychiatric wing for a while.

"I just don't know what to do" David said. "There's Katy to be looked after but I can't keep taking time off work."

He had been called home several times in the preceding weeks. Julie was not taking her medication and often phoned him to say she couldn't cope. He never seemed to get exasperated or run out of patience with her despite all the problems.

"The social services could arrange foster care" I suggested. "It would only be temporary when you are working and Katy would be well cared for."

"No, I don't want that" he said. "I'll phone my mum. She'll probably come and it'll be easier for visiting Julie."

We talked about referral to Social Services which I felt was now strongly indicated. David wasn't keen but agreed reluctantly. Julie's mental health was so unstable that it was important Katy's needs were discussed. There were implications for the future and these should be addressed.

Once again I was grateful to be returning home after a long day, to the relative normality of my own family. The future looked bleak for David and Julie with no obvious answers to their problems.
CHAPTER EIGHT

At the end of April the new surgery premises were ready. The purpose built health centre was only about half a mile from the old house which was used as the previous surgery. There was so much more room. I moved into my office on a glorious spring day looking forward to all the opportunities it would bring. The doctors, nursing staff and clerical staff were all pleased to be moving. Only one person was not. This was Lucky the surgery cat. She was indeed aptly named, because she had been rescued by one of the doctors from a dustbin, where she had been placed in a plastic bag when only a tiny kitten. Lucky led the life of Riley. She didn't have to wait for an appointment when feeling off colour. Two of the four doctors would always give her priority treatment, and if they couldn't solve the problem themselves she was taken at once to the vet, regardless it seemed of the human patients waiting for attention. The practice manager fed her with the choicest cuts of fish and meat. She wasn't at all keen on proprietary brands unless it was the most expensive. The old building had a ready made cat flap so Lucky could come and go as she pleased. There was no such facility in the new premises, and even her adoring co-owners drew the line at adding one. She hated being locked into a small room with her cat tray, despite the caretaker returning each evening at eleven o'clock, in order to give her the maximum amount of freedom, but the newly installed security alarm would have been activated by a roaming cat.

It was important not to try and take on too many things at once, but clearly the large meeting room afforded a good opportunity for health promotion activities. It was also decided that another Health Visitor working part time hours would join me at the practice, allowing us to do even more. After consultation with the other staff, it was decided to start with ante natal classes, screening of patients over seventy-five and weight control classes.

As expected, weight control appointments were always in great demand. At first there was a notice in the waiting room, inviting people to give their names in at reception if they wanted to come. This soon had to be taken down, as word of mouth produced plenty of willing participants. Those who were referred by the doctor for medical reasons were always given priority. It would have been lovely to imagine that the phenomenal success of this project was entirely due to the wonderful results. In reality it was probably more likely to have been the fact that attendance was entirely free, whereas commercial groups were quite expensive.

One of the first people to attend for a weight control appointment was Fatima. I was delighted to see her, as I had been to the Housing Department to explain the unsuitability of the estate where they had been given a house, and knew that they had already moved. She spent a lot of the time at her parent's house, but at least the neighbours on the new estate were very pleasant. Fatima was still feeding Zora, who by this time was quite plump and looked a mini replica of her mother. She was six months old, a happy vocal baby who liked and usually received non-stop attention. Fatima had always worn western clothes but they were normally fairly old-fashioned ones. Today she was wearing jeans and a jumper. The jumper was very bright orange with a large yellow flower on the front. It was tucked into the trousers and emphasised her plump shape. It was now quite easy to communicate with her, so I asked why she wanted to lose weight.

"Doctor say blood pressure too high. Better lose some weight."

This was said with one of Fatima's wide sunshine smiles and I hoped dieting wouldn't make her miserable. From what she told me it seemed that the main problem was all the snacks she was eating between meals, so we talked about stopping these.

"Will the milk for baby be bad?" she queried. I reassured her that it would not make any difference and persuaded her to give Zora more solids and less milk.

"My man look for work in factory" she said. "All work in house done now so he earn monies."

Sohail was certainly very industrious. He was as thin as his wife was fat. He always seemed to be occupied. Clearly he was very intelligent but his English was limited. He was obviously prepared to take any job offered so that he could provide for his family. I sincerely hoped that he would be successful, and felt that his achievement was more likely than Fatima's daunting task of shedding five surplus stones.

It was a constant revelation to me how very little people knew about food especially in terms of calorie content. Beer was not perceived to be fattening because as one man told me,

"It's liquid and comes out the other end."

A lot of people were convinced they couldn't eat bread and potatoes but didn't think the amount of meat and butter mattered at all. When the clinic had been running for some time it was necessary to be much stricter, as some people were just coming for a chat, flagrantly breaking the rules. Once I saw a man in the park shamelessly licking a huge ice cream complete with a flaky bar. He nearly jumped out of his skin when he recognised me.

"It's not mine, honest. It's for my grandson."

Despite the problems, however, the clinic did enjoy a good measure of success and enabled me to get to know a lot of people.

Laura's boyfriend Richard was in the waiting room as I passed through to go out on home visits. It was during the Easter holiday period so Ryan wasn't at school. Laura was obviously in the doctor's office but Richard was laughing and joking with Ryan and the baby. He was still in his policeman's uniform and I noticed that Ryan had put the policeman's helmet on from the surgery toy box.

Susan and family were all at home when I called, sadly poor Susan needed major surgery. She was due to have a total hysterectomy the following week. This meant that her uterus and ovaries would be removed, but the surgeon was confident it would be a complete cure. She would be in hospital for a week or two and seemed fairly confident that Ken would cope with the children. Social Services couldn't really justify much help as Ken was not working, but I had managed to persuade them to get someone to call in each day to check everything was all right. Much to my surprise Ken had agreed to this arrangement.

Susan was not upset that she would be unable to have any more children. She was progressing so well with her reading that she now wanted to go to typing classes. Of course she was concerned about Shane and Sharon but she had some good friends who had promised to help Ken if needed. The house was still very cluttered but was much cleaner than when we had first met.

"Can you talk to Ken?" she said. "He doesn't understand what I'm having done and thinks we won't be able to do anything after the operation."

Ken came in from the garden. Sharon followed him in, bringing large clumps of mud into the room from her Wellington boots.

"What would you like to know about Susan's operation? I asked."

"She's having some things taken out isn't she?" he said. "She says one is as big as a pear, and then there's the other things. What'll happen when we you know what?"

"He thinks there will be a big hole and his whatsit will just wiggle about inside." Susan said. "I've told him it's not like that."

I drew them a rough diagram of the female organs, and explained that apart from there being no more children, making love would just feel the same once Susan had recovered from the surgery. Ken was a man of very few words but I think he was reasonably satisfied with this explanation. Susan was young. She had made an effort to lose some weight and provided the cancer had not spread should recover well from the operation.

In clinic that afternoon I was very surprised to see Julie and Katy. It transpired that she had been discharged from hospital a few days ago. She didn't look very happy. Her clothes were clean, but her hair was greasy and her face pale and devoid of make-up. She held her shoulders in a hunched position and when she spoke there was no eye contact.

"I'm feeling better," she admitted in answer to my question. "Especially now David's mother's gone home. She makes me feel completely useless and just takes over."

"Were you pleased to see Katy?" I said.

"Yes I suppose so, but she doesn't seem to care much. She's probably better off being looked after properly by someone else."

"She's only a baby now," I said. When she gets older she'll really need her mum."

"They'd probably both be better off without me", she said.

I tried to have a conversation with her but it was hard going. She spoke in a very flat voice and it was difficult to steer the talk towards any positive things. There was just one hint of emotion when we touched on the subject of David and how he was coping.

"He's so calm all the time," she protested. "I wish he'd be a bit more forceful and get cross sometimes. It's like he's so scared of upsetting me he just agrees with me and it gets me mad."

It was understandable why David must have been unwilling to be controversial, and really quite amazing that he continued to put up with his home situation without cracking up. He had always come across as being extremely placid, but unfortunately now this didn't suit Julie. I hoped she would stay on her medication and become stabilised so that they could start to understand each other. These continual crises combined with a young baby were not conducive to this. Julie really needed to learn to like herself more, but the main obstacle to be overcome before any work could be done in this direction, was to persuade her to continue with the essential drugs. There was now a Social Worker allocated to the family and hopeful the situation would be well monitored, but I was not too optimistic.

It was going to be the first ante natal group for new parents, to be held at the surgery that evening, so I was anxious to get away from Clinic promptly. We started to put all the toys away and stack the chairs up, hindered as usual by the toddlers. Soon the room was empty except for one person. Lisa was there with her two youngest children and she seemed strangely reluctant to leave.

"Is everything ok?" I asked her. She looked so miserable sitting there. I wondered what was the matter. Dean had been out of prison for some time now. She was also in the early stages of her fifth pregnancy, so would normally have been feeling cheerful and well. She had a large healing bruise on her left arm, but it was unfair to assume Dean had caused it. He was usually much more considerate when she was pregnant.

"We're closing up now" I tried, after my first enquiry had not been answered.

"I don't want to go home," she said.

"Where are Louise and Kevin?" I asked. They were her two oldest children who would have been home from school.

"They're at my Grandma's but I don't want to go there either."

"Well tell me the problem and perhaps we can sort it out" I said, not very hopefully.

Suddenly all her bottled up worries spilled out.

"He's got his jemmy and mask out to do a break in. There's three of them but they won't just stick to the ones it's ok to do. They'll do some old people and it's not fair".

"You're thinking about your grandma," I said.

"They won't go to her house of course," she said. "But when I see her with the kids and how good she is to us."

"It could be someone else's grandma," I said. "They'll have people who love them just the same. What do you think you should do?" This question was met with silence.

"What if an old woman gets hurt?" I tried. "I know it's not happened before, but it could. Then it would be GBH. Dean would be in prison for a long time and you would have to live with the thought of someone's grandma being beaten up."

She seemed to be persuaded into action and agreed to turn informer as long as the Police didn't let Dean know who it was. This was completely understandable, so I hoped the Police would feel the same way. It was decided that we would drop the two youngest children off at her grandma's, and then go together to the Police Station.

The Police were more than willing to co-operate with Lisa so that she would not be implicated. There had been a spate of burglaries and the crime detection figures were very low, so they needed all the help they could get. They asked her a lot of questions about Dean's mates and how long he was usually away from home. Lisa actually knew very little about Dean's activities, criminal or social. They didn't enjoy the sort of relationship that encouraged confidences. Dean came and went as he pleased. He helped her with the children when he was around, gave her money from time to time to supplement the Social Security payments, and had fathered her last child. The Police were very skilled at extracting information. They brought us a tray with tea and biscuits, and thus lubricated, Lisa was able to give them the lead they wanted.

"He usually gets rid of the stuff at car boot sales. I've been to one or two. You can get some lovely things."

The Police were obviously satisfied with this. They knew as well that Dean would be out that night, though Lisa wasn't able to give them much information about his accomplices.

We were at the Police Station for about an hour and ten minutes. It was ten minutes too long. My car, which had been parked on a road where waiting was only allowed for an hour, was sporting a fixed penalty parking ticket. It was immediately outside the Police Station, so had no chance of escaping detection.

The new surgery looked entirely different when I let myself into the building just before seven that evening. Lucky followed me in meowing and rubbing herself against me hopefully. She was already becoming a little overweight and she certainly wasn't going to get any delicate morsels from me.

The chairs in the waiting room were all stacked neatly and the toys put away in their box. The midwife had done several sessions with this group at the health centre but was unable to be there for this one. I decided not to use the meeting room upstairs, as it would be easier for security purposes to keep everyone on the ground floor, and the waiting room was more than adequate. This decision turned out to be the right one for reasons I could never have visualised.

As seven o'clock the first couples started to arrive. Quite soon there were seven couples in the waiting room and three women who had come alone. Most of them already knew each other by this stage and were chatting quite freely. One or two of the men looked as if they had been dragged there reluctantly. They would probably have been much happier in the pub. One of them looked exhausted and I heard someone say that he had come straight from work. I resolved not to let the session go on for too long, but to try and get all the relevant details given as succinctly as possible.

The subject to be discussed was feeding their new baby. For most of them they would be doing that in about four weeks. One lady looked as if labour was imminent. She kept rubbing her huge bulge and shifting uncomfortably in the chair. I hoped she wouldn't go into labour, or at least that the onset would be slow. My midwifery training was in the dim and distant past and I certainly didn't want to have to put into practice the skills that were largely forgotten.

To promote discussion I gave them a team activity and divided then into four groups. They were all given a number of statements, which they had to decide to put under the heading " "Breast or bottle feeding". Some of the cards were applicable to either and hopefully would lead to questions.

Lucky was mewing and scratching at the door, so I opened it to let her out. A man was standing just outside.

"I want a doctor," he said.

"I'm sorry," I told him, "It's Wednesday and half day closing. There's a surgery tomorrow morning." It was then that I looked more closely at him. He was a small slim man of around sixty. His face was a putty grey colour and the effort of speaking had left him clearly exhausted.

"Are you alright?" I asked him. It was a stupid question as he most definitely was not.

Rushing back into the surgery, I fetched a wheelchair from the porch and managed to get him into it. The evening was quite cool, but I feared the blueness around his lips was not simply due to the drop in temperature, though he was only dressed in a shirt and trousers.

When he was resting on the couch in one of the doctor's rooms his colour came back a little. I felt his pulse, which was very fast and listened to his blood pressure, which was very low. Then I asked him how he had come to the surgery.

"I was driving past on my way home," he said, "when I felt out of breath and got this really bad pain in my chest. It was like someone crushing me."

"Were you sweaty or faint?" I asked him.

"Yes" was the reply. "I was wringing wet and felt cold and clammy."

The history he gave me made it reasonably certain he had suffered a heart attack. I decided to give him a low dose of aspirin, which is an excellent first line treatment, but there were none to be found in the surgery. There was a doctor on call but this would waste valuable time.

"I'm going to phone for an ambulance," I told the man. "It sounds like you need your heart checking over, and the paramedics are the best people to deal with it now."

After phoning 999 I popped in to see how the group was doing. The man was looking much better but I daren't leave him too long. They were still in the throes of discussing the cards and there was lots of laughter and lively chat.

"Can you phone my neighbour to collect my car?" the man asked me. "I want him to tell my wife as well. She suffers with her nerves and it'll be better if she hears it from him."

There was only just time to make the phone call before the ambulance arrived. They took the casualty out on a stretcher. This had been my first bit of nursing since leaving hospital and I hoped that he would make a full recovery.

Back at the ante natal class discussion was still in progress. There was quite a lot of disagreement about the statement "It can be more restful." Most of the men thought it should go under breast feeding, as they felt they would get more rest. The women, however, wanted to put this statement under bottle-feeding.

"It can be quite restful for the mother if she has visitors she wants to get away from. She can take herself upstairs and stay there until they've gone," I said. After all it was my job to steer them towards breast-feeding as much as possible.

The lady who had previously looked as if she was about to give birth was now very uncomfortable and was shuffling about in her chair.

"Are you alright?" I asked, but shouldn't have, as my eyes told me that she wasn't.

"Actually I think my labour's started," she said. "I've lost some blood and now I've got pains coming quite often."

Though I had dealt with the medical emergency quite competently, this was entirely different. The last baby I had delivered was fifteen years ago and more up to date skills than mine were certainly called for.

"It's best if you take your wife to the hospital in your car," I told her husband. "It'll only take five minutes and you should have plenty of time with a first baby."

"What about her case with her stuff in?" he said.

"I'd take her to the hospital first," I said, "then go home for her things."

It was difficult after this second emergency to concentrate on the rest of the programme. We talked about labour and how you knew that it was starting but fortunately the rest of the women looked as if this would not be for a few weeks. We then discussed a few practical tips about how to sterilise feeding equipment. It was quite obvious to me that I had failed to get the message clearly across when one lady said.

"Do you have to dip your breasts in that sterilising fluid before you let your baby have a suck?"

Time to bring the session to a close I decided, before anything else happened. It was too late something did! With a loud thud one of the fathers slid to the floor. He appeared to be totally unconscious and I had visions of dealing with the second heart attack of the evening. Fortunately, a cursory examination revealed that it was just a faint. It was the man who had come straight from work without his tea and his blood sugar was probably low. I lay him down on the floor with his feet elevated, feeling thankful that he wasn't the partner of the lady who had been about to give birth. He soon came round. He drank a cup of tea and ate several biscuits and was well enough for his other half to drive him home.

I let myself out of the building around nine thirty, thankful that the day was over. Lucky was nowhere to be seen but the caretaker would be coming back. I wanted to get away as soon as possible before some other emergency occurred, and resolved not to take classes on my own in future.
CHAPTER NINE

"What are you doing for lunch today?" one of the practice nurses asked me. It was mid February and almost a year since we had moved into the new surgery. All the staff had got to know each other well, and sometimes we did have lunch out if it was a birthday or some reason to celebrate.

"I thought you might be going to the fish and chip shop", she said. This made me look at her rather blankly, as I could only remember two occasions when I had indulged myself at the local chippy. She then started to laugh and told me what one of the patients had said.

"Do you know who I saw? I saw that slimming woman at your surgery sitting in her car scoffing fish and chips. She doesn't practice what she preaches."

It was the weight control session that morning. There had been a lot of successes and I was feeling pleased that the results were good. This was a sobering thought that just as the patients were always aware that I might catch them out, they were watching me too. Clearly indiscretions would have to take place out of the area.

Helen was in surgery with her foster mum. She had come for a routine medical and had been in her present placement for six months. Mr. and Mrs. Spencer were a couple in their mid fifties whose family were all grown up. They would normally have been too old for long term foster parents, but given Helen's special problems they were ideal. Psychological tests on Helen were fairly conclusive that she had suffered sexual abuse, but absolute proof would be difficult. In any case she had no contact whatsoever with her real parents. It was at Helen's request and she would not be persuaded otherwise, that no visits were made to either her mother or father. Her parents did not contest this. Mary her mother was now drinking even more. Her liver was severely damaged and she ought to have been in hospital. Probably she was frightened there would be no access to her supply of alcohol, so she always refused treatment. Most of us who knew the circumstances well, had our own theories about why Helen was apparently victimised. It is possible Mary was already drinking too much when her third child was born. Alan could have been deprived of sex and turned his attentions to Helen, causing Mary to drink even more and vent her anger on her daughter. Whatever the reason, Helen looked very well now. She had put on weight and though she was still short was at least growing. Seeing her with her foster mum chatting freely to each other, one could imagine that there were no problems. In reality it was highly probable that though the physical abuse could be repaired, Helen would carry the mental scars for the rest of her life.

The appointments for slimming were all fully booked as usual. Now the group was well established it had become necessary to be quite strict. A very small minority were discovered to have medical reasons for not losing weight, and it was great to be able to identify and treat these problems. There remained those people who were obviously less than truthful about their food intake. According to their account of the calories they had taken in, the weight should have been rolling off. Probably they were not aware they were cheating, just like a smoker who lights a cigarette without realising it. The best way of dealing with this was to ask them to write down everything eaten and drunk for a week. They either came back the next week having lost weight, or decided not to come back again.

My first lady that morning was one of those who plainly came for a weekly chat. She was not losing weight, and when asked to write everything down, simply said she had forgotten to bring it to show me. She had a lot of intractable problems at home and used to visit the doctor every week. Now she had transferred her allegiance to me. Naturally enough the doctor in question was most anxious that I should keep her on, but her days with me were numbered because there was a waiting list for the group. She was very distressed on this particular occasion, and as usual she overran the allocated time. I was just about to tell her that she shouldn't really come again when she said.

"I can only manage because I come to see you every week. No one else understands how I feel. It's the thing I look forward to and it keeps me going."

Once again I chickened out, making her an appointment for the following week.

Fatima came for her weight check. Despite the problems of having to adapt our western diet to the food they were used to eating, she had lost a lot of weight. She was dressed in leggings and a tight sweater. The most noticeable feature was her hair, which had been dyed bright purple. Strangely enough it really suited her, but she had changed so much from when we had first met. Zora was a delightful toddler totally absorbed in playing with the toys in my office. Fatima was going weekly to a mother and toddler group, and Zora was already saying words in both languages. Fatima looked as always her usual happy self, so it was quite a surprise when she said.

"I'm very sad. I no come to see you any more. Sohail tell me he like his woman plenty cuddly, not all bony."

This was said with a big cheerful smile and hand movements to indicate the desired shape she should be. Her weight was now almost in the normal range, so I agreed with her that staying at the present weight would be fine. I was going to miss her weekly visits. She always cheered me up whenever I saw her.

A middle-aged couple came every two weeks. They had now been on the programme for three months and were in competition with each other to see who could lose the most weight. Because they were dieting together they were very successful and there was little variation in the amount lost each time. They were amazed at how much energy they had now they had shed the surplus weight and were keen to continue.

A young man climbed onto the scales and was exactly at his target weight.

"You can buy your motor bike now," I said, knowing his girlfriend had promised him one if he lost weight. He had been looking forward to this prize for some time, but didn't seem quite so elated as he ought to have been.

"Sarah's pregnant," he said, "so I don't think we can afford it." Then he said with perhaps not quite so much enthusiasm as a new bike would have mustered.

"We're looking forward to it though."

My last patient that session had lost so much weight it almost caused a serious problem.

"I was in Sainsburys," she said, "and when I bent down to get some ice cream out of the freezer my glass eye fell in." The glass eye no longer fitted snugly since her weight had altered.

"They had to empty the freezer," she said, "but they found it and I'll have to take it in to get it altered".

Before lunch I made a home call to an elderly lady. She was eighty-four and had previously enjoyed excellent health. She used to go into town every day and did all her own work in the house, even baking bread, which she said, stopped her getting constipated. Her husband had died twenty years before but she coped very well on her own. Unfortunately, it was her only son who had suffered the heart attack the night of the antenatal class, and I learnt later that he'd died in the ambulance on his way to the hospital. His mother was inconsolable that her son had died before her, and she simply gave up. There were no grandchildren and her daughter in law never visited as she had her own problems. We arranged home help and meals on wheels but she was losing weight and probably wasn't eating them. Today was no exception. She was sitting in her chair not reading or watching television. The sympathy cards sent to her almost a year ago were still up, and she always refused the suggestion of bereavement counselling. She tolerated me, perhaps because of my link with her son, but I knew that my visits were very inadequate and wished I knew how to get through to her.

Back at the surgery there was a magnificent bouquet of flowers on the reception desk. Roses, freesias, carnations and lilies wrapped in cellophane and decorated with a large pink bow. Perhaps it was from my better half I thought fleetingly. It was Valentine's Day after all, but though he never forgot special days, sending flowers to my work place wasn't his usual style. The card simply said, "Be my Valentine." It was addressed to Louise, one of the young attractive clerical staff. That dashed my delusions of romance.

"Hey Louise," I said, going into the office, "I like your flowers. You've got a very romantic husband."

"That's just it", she said, "They're not from him, he'd never do anything like that."

"She thinks they're from one of the patients who are always chatting her up", Louise's friend said.

"You can take some home if you like", Louise said, "We may as well share them. I daren't take them home, Paul'll go mad."

One of the doctors told me Susan was depressed, and she had asked for some medication to help her, but he didn't want to prescribe any because he felt it was probably due to home circumstances. I agreed to visit to see if she would confide in me. The operation had been completely successful. She hadn't needed any follow up treatment and until now there seemed to be no complications. The last time I had seen her was just before Christmas. She was also learning to type with a view to getting a job. The children were both well and though she and Ken were not very close he was helping in the house a bit more. I told her the purpose of the visit but she was reluctant to confide in me. She asked a lot of questions about Sharon and Shane but steered the conversation away from herself.

"Look," I said at last. "There must be something worrying you. The doctor doesn't think you need tablets but you're feeling down, why?"

"Will you promise not to tell anyone if I say what it is?" she said at last.

I had got caught in this trap before. Someone had made me promise not to disclose information, and then told me about her husband's paedophile activities. Naturally I had to break the promise, so was now very wary of agreeing to keep an unconditional confidence.

"As long as it doesn't involve any criminal activity,that's the only reason I have to tell someone."I replied.

She then told me an incredible story. She had met a man at the centre where she went for reading and typing. They had met at the Christmas party. She told him she was a single parent, and even though he lived less than a mile away from her, they were having an affair.

"But how do you manage to see him apart from at the centre?" I had to ask.

"I've told Ken there are night classes twice a week", she said, "I go round to Mick's house then. He comes to our house once a week when Ken is in town and at the "Social Security".

There was of course no danger of her becoming pregnant now, but she was playing a very dangerous game and sooner or later would be caught out.

"It's doing me in", she admitted. "I love being with Mick. We get on ever so well but I don't really want to give up Ken either, after all he is Shane and Sharon's dad".

"Well, he'll find out soon if you carry on like this", I said. "You'll have to decide what to do."

"I feel a bit better now I've told someone", she said. It was not a long term answer to her dilemma. I hoped she would decide what to do before the two men met as surely they would.

Laura was outside the school as I drove past waiting for Ryan. I stopped to arrange an eighteen month visit for Patrick, because she was out so much I had to catch her when I could. Her hair was much longer and tied back in a ponytail. She was chasing around after Patrick who was trying to climb onto the school wall. It was hard to imagine watching her with her youngest son that she was old enough to be his mother. Certainly she looked too young to have a child already at school.

"We're buying a house on the new estate", she told me. "There's my money from my aunt and Richard has some savings, so there's plenty for a deposit."

"Are you moving soon?" I asked her.

"Well Richard says it'll take a while to get things sorted out but it shouldn't be long. I'll be glad to get out of the rented house and there's a good garden at the new one."

It was easy to arrange the assessment visit because Richard was apparently away for a few weeks on a training course so Laura would be in more. She looked so well and happy these days that it was a pleasure to see her.

I was not looking forward to my next visit. David had telephoned because he was so worried about Julie. His mother was now living with them. This was causing problems with David's father, and though it enabled David to go to work knowing Katy was safe, Julie was certainly not happy about the arrangement.

David's mother opened the door the moment I touched the bell.

"It's a good job you have come", she said. "Because we can't go on much longer like this. She's not getting any better you know and someone's got to do something about it."

She was obviously very distressed. Though normally very polite she didn't even go through the formalities of greeting me, nor did she ask me to come through to the lounge.

"Where is Julie?" I said.

"She's upstairs in her bedroom where she stays all the time", was the reply. "She doesn't do a thing for Katy when I'm here. If only she'd take notice of how I do things she might shape up a bit".

I did feel some sympathy for Julie and could understand why she kept out of the way. She already felt inadequate with her own family, so her mother-in-law's attitude would only serve to compound this.

"Can I come in so we can discuss it?" I asked.

"Discuss, discuss, that's all any of them do", she said. "We've had social workers, psychiatric nurses, the lot and we're getting nowhere. I'm telling you, our David can't go on like this". When we were finally in the lounge I said to her.

"What do you think would be the best thing to do?"

"I think that Katy should come and live with us in Birmingham to give Julie a chance to sort herself out."

"But what about David?" I said. "He wouldn't see very much of his daughter."

"Yes, well nothing's ideal is it. He'll probably end up leaving her anyway. She'll never be normal. We regret the day he married her."

It seemed she was not aware that Julie was now four and a half months into her second pregnancy. I wasn't going to tell her, but it may have accounted for the fact that Julie was more unstable again after having had a few months when she coped fairly well.

"My husband is going to try and get Katy made a ward of court", David's mother said. "She's not a fit mother. Did you hear what she did at the weekend?"

I had, but there was no way she would be stopped from recounting the tale again. Julie had gone out in the evening without telling them. There was a phone call from the Police at eleven thirty to say she had been picked up. David collected her from the Police Station. She was dressed in a very short skirt and sweater. She appeared to be drunk but it could have been a combination of alcohol and her medication. She was also trying to invite one of the men in the pub to take her home. Fortunately, the landlady realised that she wasn't well and called the Police, otherwise the situation could have been worse.

"How's Katy?" I said, but there was no need to ask. She had been playing in the room whilst we were talking. Though not yet two, she was already able to amuse herself. She could do small jigsaws and loved looking at books. When I had done her eighteen month check just after Christmas, she had performed well above average for her age. For this reason it was highly unlikely that any court would take her from her parents, unless they agreed to it. Any signs of insecurity and emotional deprivation would be unlikely to show until Katy was much older. In any case, when David was at home he was excellent with Katy and he wouldn't want to lose either his wife or daughter. I knew there was no point trying to explain all this to David's mother but I did mention "We have arranged a child minder three times a week so that Katy is looked after and Julie gets a rest."

This was not the right thing to have said.

"What does she want a rest for? She's only got one child and no other job. It's time she faced up to things."

"You're waiting for the psychiatrist to call aren't you?" I said. "I'll go up and see her if it's alright?"

The bedroom was very dark. The heavy curtains were shut and the window was closed. There was a stale sweaty smell in the room. Julie was lying curled up with her face away from the door, although she looked as if she was asleep I was pretty sure she wasn't. Even though I spoke to her and touched her gently there was no response, but just as I was about to leave she opened her eyes. She looked really ill. Her hair was dull and unkempt. Her face chalk white with her eyes protruding and staring wildly. She was wearing a baggy tee shirt, which was crumpled and stained. She looked so utterly sad and frightened and I felt real compassion that her mental illness had caused such devastation. She was a pretty intelligent woman, with a lovely home, a husband who really loved her and a gorgeous baby, but she was controlled by her psychiatric condition. As I looked at her, there came the realisation that although I had seen her in much better mental health than she was today, I didn't really know her because she had been ill for so long. The hospital said she could be very violent, but though she was indifferent to me at times there had never been hostility. I tried to give her a hug but her body was stiff and there was no response. As she lay there, a few solitary tears rolled onto her cheeks. She made no attempt to wipe them away. Then in a voice devoid of any expression she said.

"I don't want to go back to hospital. I wish I was dead."

"They'll be able to help you", I said. "They can sort out the right medication with the new baby coming, and if you stay on it you should feel better. Please don't give up."

Just then the psychiatrist arrived. It wasn't the same one that she usually saw and I wondered how she would react as I went down to join her mother-in-law.

We didn't have long to find out. Within a few minutes Julie could be heard screaming and shouting. There was a loud thud quickly followed by the sound of broken glass. The psychiatrist came rapidly down the stairs dabbing at a small laceration on the back of his hand.

"I'm going to phone her GP so that we can section her", he said. "There's a broken glass in the room but you'd better wait until he gets here."

The section would mean that Julie would have to be admitted to the hospital against her wishes. Under the circumstances there was no other solution, but I was sorry it would have to be done like this. Julie's mother-in-law was starting to tell the psychiatrist exactly the same as she had told me, so as she would not be alone I took the opportunity to leave knowing the doctor was on his way.

It was quite late when I arrived back at the surgery and normally I would have gone straight home. However, there was my share of Louise's Valentine flowers to collect and I was looking forward to taking home some roses and freesia. They were not in the sink in my office where I had left them.

"Who's taken my flowers?" I asked, but there were only two girls left in the office so I wasn't very hopeful. Louise just worked part time and she would have left at three o'clock.

"Haven't you heard what happened?" one of the clerks said. "Louise came back in after she'd picked the children up from school. Paul had phoned her and asked in a roundabout way if she'd had a good day, so she knew he'd sent the flowers."

"What on earth did she do?" I said. "They'd all be divided up."

"She had to take them back to the shop and get another bouquet made up", they told me.

"I bet her children will tell their dad", I said.

"Oh she had to promise to take them to McDonalds for tea as a bribe to keep their mouths shut."

Poor Louise I thought, whilst driving home, refusing to believe that her husband could be romantic had ended up causing her trouble and expense. Just as I pulled into our drive my husband arrived at the same time carrying a large bunch of flowers. "Tell you later darling" I said, when he asked why I was laughing.
CHAPTER TEN

My first visit of the morning was likely to be a wasted journey, so I had only allocated the time needed to drive there. We were now giving a third of our home appointments to the elderly. These visits were proving to be very successful, in terms of identifying unmet needs of the practice patients over the age of seventy-five. It had been necessary to sell my mini and buy a car with a hatch back, because many of the elderly needed home loan equipment which we could supply. As I managed to sell the mini for exactly the same amount it had been bought for, there was certainly no reason to grumble. It was highly unlikely that my newer car would serve me so well.

The lady I had come to visit was, according to her surgery records, in her ninety sixth year. Some patients have records that that are so thick they can hardly be filed, but this lady's records consisted of one single page. She had lived in the area all her life and only seen a doctor three times. The last surgery visit was thirty years ago and the doctor she had seen had now retired. There was no phone number but I had written to tell her that the Health Visitor would be visiting. I fully expected that someone else would now be living in the house.

"You thought I was dead didn't you?" the tiny old lady said as she opened the door. She must have seen the astonishment on my face but I tried to cover it up.

"We thought you must have gone to live somewhere else because no one has seen you for so long."

Miss Wood was probably no more than five feet tall but because her spine was so curved she appeared much smaller than this. She walked slowly from the front door to the kitchen without the aid of a stick. Her hands were gnarled with arthritis. She rocked her body from side to side in order to balance, rather like a toddler first learning to walk. There was an easy chair in the kitchen and an Aga type cooking range. The room was very warm and cosy though quite old fashioned. It looked clean and orderly. The oven was shining and the hand made peg rugs looked bright and dust free. Miss Wood lowered herself painfully into the easy chair exposing swollen twisted knees and grossly distorted feet.

"Who does your cleaning for you?" I asked. "It looks lovely".

"I do it myself" was the surprising reply. "It takes me a long time but I've nothing else to do."

"What about your shopping?" I tried, thinking she surely couldn't manage to walk outside.

"I have the travelling shop twice a week and manage with that."

It was too late now to get her severe arthritis treated, but there were lots of things she could have to make her life easier. She was taking paracetamol and said that her arthritis was no more painful than could be expected for her age. When I asked why she had never been to see the doctor, she said.

"They're only for ill people. I'm all right. It's only my age. What else can you expect?"

She refused any offers of help with the housework and she was probably right to keep as active as she could. She did agree to have a home help call every morning to light the kitchen range. It must have taken her such a long time with her twisted hands. I told her that she could have a special bottle opener, to save her opening jars and bottles with her mouth. She could also have an adapted chair and possibly equipment to help her with the stairs and toilet needs. At present she was using a bucket for the toilet during the day. It appeared she only went up the stairs at night time on her hands and knees. It must have taken her such a long time, but throughout my visit she never once complained, expressing amazement that there was any help available. She made me a cup of tea and I had to resist the urge to help her. Despite having no extended family her mind was really active. Thankfully her vision and hearing were still quite good, and she watched news and current affairs programmes on television.

Before leaving she said she would allow me to make a referral to the occupational therapist so that she could be fully assessed for equipment to make her jobs a little easier. I was glad too, that the home help would be calling each day, not just to relieve her of the painful task of lighting the range, but so that she would have a regular visitor.

"Thank you so much for coming" she said. "I didn't know you could have all these things. I've enjoyed the visit."

"So have I", I replied, as I bade her farewell. It had been my pleasure to meet such a delightful lady.

Lisa's grandmother was the next person to see. She was already known to me but Lisa had mentioned she wasn't so well. Apparently she was having diarrhoea both day and night but was too frightened to go to the doctor. I felt very concerned and somewhat pessimistic that her symptoms could point to something very serious. Lisa relied on her so much, not only to help with the children but she was more of a mother figure that Lisa's own mother had ever been.

Lisa opened the door carrying the latest arrival. He was called Gary and was now seven months old. Although Dean was back in prison again, he could have been the father. The baby was very handsome. He had dark wavy hair and deep brown eyes. There were many characteristics that reminded me of Phil but I would never know if it were just my imagination. Phil hadn't been seen around the estate for quite a while now.

Lisa's grandmother was always cheerful and today was no exception.

"I don't know what our Lisa's been telling you," she said, "but I'm alright. It's probably just something I've eaten."

She didn't look all right. There were signs of obvious weight loss and her eyes had lost their sparkle. She also looked very tired which was not surprising when she told me about her diarrhoea.

"Are you still taking your pain killers for arthritis?" I asked her.

"Yes I am, but they aren't doing me any good. My legs and back are worse."

This was bad news, as the painkillers normally make people constipated.

"Can I see all the tablets you take?" I asked.

She only had two sorts of pills, but checking the labels I learnt a valuable lesson for future assessment visits of the elderly, and immediately felt much happier about her prognosis. Perhaps she had difficulty reading the small labels or had simply made a mistake, but the tablets she was no longer taking which she thought were for constipation, were actually her painkillers. She had in fact been taking strong laxatives four times a day.

"It's an easy mistake to make," I said. "Let's label the bottles clearly so it doesn't happen again. I'll come and see you in a few weeks to make sure you're OK."

"You can if you want", she said, "but I'm sure there's folks who are more ill than me."

Mr. Scattergood lived in one of the cottages on the outskirts of town. The cottages had very small rooms with low ceilings. They looked very picturesque but the walls were stone, and as there was no central hearing they could feel very cold. The sun was shining this day but there was a brisk wind. I opened the small side gate, which led into the back garden. There was a panoramic view of rolling countryside and. I could see the spire of Saxford church in the distance. In the next field some early spring lambs were gambolling, whilst their mother kept a watchful eye over them. Pausing for a moment to enjoy the splendour of this country scene, I reflected on my telephone conversation with Mr. Scattergood the previous week

This gentleman was ninety-four and had been living abroad for many years, coming to Saxford following his wife's death. For the last fifteen years he had never seen a doctor. He received my letter giving him an appointment for a home visit to assess his needs, but he telephoned to say he was well and a visit wasn't needed. Three days later he telephoned again.

"If it would be convenient for you to call, I should like to change my mind and accept your offer."

I reassured him that I would be delighted to call, wondering what had made him decide to have a visit. He told me his reason.

"I've been thinking. I'm very well but I am ninety-four so perhaps you'd better give me the once over. After all I'll die soon and it might be a bit awkward for the doctor knowing what to put on the death certificate if no one has seen me."

Mr. Scattergood came to the door remarkably quickly for a man of his age. He was fairly tall and very slim. His bearing was erect almost military so I thought he had probably been in the armed services whilst working abroad. He didn't walk with a stick and appeared not to have any traces of arthritis. It was very difficult to believe he was so old and I told him so, asking him what was the secret.

"I don't take any medicines except cod liver oil every day and I go out for walks with my little dog," he replied.

The little dog, a Yorkshire terrier, had barked furiously at me, but was quickly reassured and was now sitting docilely at his master's feet.

Mr. Scattergood's blood pressure, pulse and urine tests were all remarkably normal. His diet was good and he enjoyed cooking, telling me his wife had taught him when she knew her illness was terminal.

He told me they had been missionaries in Malawi for forty years. They had come to Saxford to be near his sister who was now also dead. He showed me photographs and told me tales about their lives in Malawi. It was fascinating and I hoped there would be more visits needed. This was unlikely because he seemed so healthy. The countryside in Malawi looked very green and hilly and not the way I had imagined Africa to be. There were photos of Zomba plateau, which was 5000 feet above sea level. The area was interspersed with rivers and rocks making it look really attractive. There was one picture of a place called Likabula showing a waterfall and deep pool. The name in itself evoked a sort of magic, and even given the limitations of a photo view it looked magnificent.

"I can understand why you like walking," I said. "I bet you did a lot in Malawi. How far are you able to walk?

"Five or six miles three or four times a week. The country walks round here are excellent."

I asked him if he was ever afraid to be out on his own in case he had an accident.

"Not really" he replied, "In Malawi we had close encounters with hippos and buffalo, and I'm in God's hands."

He then proceeded to tell me about an incident that had occurred the week before. Apparently he was out walking as usual with his little dog, when a herd of cows stampeded across the field. He was unable to get away from them to climb over the stile, and they virtually pinned him against the hedge. I could remember reading somewhere that every year three people are killed by cows, so was able to imagine how he terrified he would have felt.

"Didn't your dog bark at them?" I asked.

"He was petrified", he said. "His whole body was quivering and he couldn't utter a sound."

"So what did you do?" I said.

"I was a bit scared at first I must admit, but there was no one to get help. So then I thought, well Arthur, you've got to die of something and this would be quite a novel way to go."

"Then what happened?" I asked, by now totally intrigued.

"There was a small gap in the hedge. I managed to push Livingstone under it, and then flattening myself to the floor I followed. It's not put me off walking" he said, anticipating my next question.

He made me a cup of tea and shared some more memories of his missionary days in Africa. Neither the stairs nor bathing posed any problems for Arthur Scattergood. I hoped that when the time came for him to meet his maker it would be very sudden, and that he would remain alert and active until then.

David's parents had returned to Birmingham bitterly disappointed that Katy was to remain in Saxford. The case had never come to the courts, because it was considered that there weren't sufficient grounds to take Katy away from her mother. Julie's parents hadn't even been to visit following her latest hospital admission, they were too tied up with their own lives in the Isle of Man to become very involved. Julie's sister and brother were both married with children as well as being in professional jobs. Her parents had tried to understand her illness at first when they thought it was just post natal depression, but now their way of coping appeared to be by avoiding too much contact.

Julie was home from hospital. Social Services had arranged for a child minder to look after Katy for two hours each day, with an option to extend the time if needed. It is doubtful if this helped Julie, because in four months she would have to cope with two children, but it was certainly a relief to David to know that there was a safety net just around the corner should there be further problems. Katy too, now an active toddler could not fail to benefit from the input of a good child minder. She was at an age where she needed some stability and at least if any further crises occurred she would be with someone she knew.

Julie's pregnancy was progressing quite well. According to the psychiatric nurse she was taking her medication, so I was not expecting to find anything untoward when I knocked at her door.

All the furniture was in its normal place. Julie looked well when she opened the door to let me in, and was obviously taking advantage of her daughter's absence to watch some television. Unfortunately she was watching a documentary programme about drought in Africa, showing graphic images of children and babies starving. It was obvious when I took a closer look at her that she had been crying.

"You'd be a lot better watching programmes which make you laugh." I suggested. "You've had your own fair share of problems and there isn't an awful lot you can do about these situations."

"I've just written a cheque out for £1,000" she said, "They need a lot of money to feed them all."

This was of course very true, but because Julie only seemed to watch this type of programme it was likely that their bank account would be quickly depleted. After we had talked for a while about Katy and discussed Julie's pregnancy, I offered to post the cheque for her and she agreed. It was probably not very ethical, but later when I phoned David to tell him about the cheque, he said they didn't have that much in the bank and was most relieved it hadn't been posted.

After a shaky start, the dental health education programme at Fearn-Lea School was now doing well. The plan was to take two groups of five year old children, matched as equally as possible for social class, and to give one group intensive dental health education but leave the control group without this. Both groups had needed to be examined at the start of the project by the school dentist. Generally the parents had been very co-operative, surprisingly so, because fifty percent of the children had neither seen a dentist nor ever cleaned their teeth. It was this that nearly caused me serious trouble.

It was necessary to show the active group how to clean their teeth thoroughly. Five year old children can do this for themselves, but an adult should also do some brushing, as young children do not have the dexterity to get in all the nooks and crannies. Enthusiastic brushing of teeth which had never been cleaned before, not unnaturally caused the gums to bleed. This looked quite alarming, but would only be a temporary problem and was certainly not injurious. Unfortunately for me, one of the children was the son of a solicitor. He told his father about the children who had never cleaned their teeth, and the next day I got a phone call.

"Did you know that actually cleaning a child's teeth without parental consent is considered an assault, and they could sue you? You ought only to let the children do it for themselves."

I didn't know this, and waited in trepidation for complaints to follow. Some of the families knew me well and I was reasonably sure they wouldn't object but I didn't know them all. Fortunately, this had been some weeks ago so it looked as if I had got away with my indiscretion.

The children were given star charts to encourage them. They could get prizes when they limited foods containing sugar to meal times and cleaned their teeth twice a day. They were mainly most enthusiastic, even checking labels in the supermarket for sugar content. Other children in the family also benefited. I was looking forward to studying the results at the end of the project.

Lisa's boy Kevin was taking part and also Laura's elder son Ryan. Helen was in the right age group but her permanent foster parents lived out of the area, and she now attended another school. Her mother Mary was in hospital dying with cirrhosis of the liver, which had almost certainly been caused by her drink problem. Wendy, Helen's older sister had been picked up by the Police in Saxford for prostitution. She was only fourteen. Probably she too would be taken into care, but sadly her life was by this time perhaps irreversibly damaged.

Laura's mum was waiting outside the school for Ryan. Laura was now at college training to be a teacher so couldn't always pick the children up.

"How is Laura's college course going?" I asked her.

"OK I think, but Laura's a bit down. Perhaps she's worried about her dad. She hasn't said anything else is the matter."

I knew Laura's dad had had a heart attack but he was recovering well.

"Will she be in a bit later?" I asked. "I need to discuss Ryan's dental charts."

"Yes, she'll be home any minute and the children are having tea with us, so perhaps she'll talk to you" she said.

Laura was at home and the house was strangely quiet when she let me in. The children were of course at her parents' house, but it was unusual for the radio not to be on, as even when she was studying there was always background music. She was dressed in jeans and a sweater, her usual college gear. Her hair was loose and shiny and she wore a small amount of make-up expertly applied, but because I knew her quite well it appeared that there was a sadness and emptiness about her.

"How's the work at college?" I asked, knowing she would be starting her first exams soon.

"I don't find it too difficult" she said. "Mum and dad are so good about having Ryan and Patrick and I think I'll like teaching."

She didn't sound very enthusiastic. Once again it was impossible not to notice that all the sparkle had gone.

"You aren't still worried about your dad are you? It wasn't a bad heart attack and he's doing really well."

She said she wasn't. We talked about Ryan's involvement with the project and I gave her some more charts. Then I realised she had never once mentioned Richard which was most unusual.

"Isn't Richard back from his training course now?" I asked.

Suddenly huge tears welled up in her sad brown eyes and then she started to sob uncontrollably. Soon her whole body was shaking and trembling with the force of her weeping.

"I'll go and put the kettle on and make some tea" I said, wondering as I said it why we always imagine a nice cup of tea will sort things out, but feeling the need to do something, as Laura was by now hysterical and beyond physical comfort.

Whilst waiting for the kettle to boil I tried to guess the source of her dreadful unhappiness. Surely Richard had not been violent? She showed no evidence of physical abuse, and he had always seemed so calm and even tempered. Laura's body was still quivering but she was now quiet. I sat beside her on the settee and waiting for her to speak.

"Richard didn't come back from the training course. He isn't coming back ever." Then she told me the awful truth. When Richard didn't return at the time he was expected, Laura tried to contact him. The phone number he had given her was unobtainable. She had never had occasion to use it before, because he had phoned her regularly. She waited for a few days worrying more and more. Finally she called the Police Headquarters who said they didn't have a policeman by the name she gave them, but they were anxious to get as much information as possible. Apparently Richard was well known to the Police force, but not as a policeman and not with the same name.

"He has been a fireman, a bus driver and a soldier" she told me. "Each time he had a uniform and knew all about the job he was supposed to be in, but of course he kept changing his name."

I can't believe it," I said. "He had us all convinced at the surgery."

"The reason he knew all about the burglaries and could talk with so much conviction" she told me, "was because he was doing them."

Just then I remembered her legacy and hardly dared to ask how much she had given Richard for the house deposit, but she told me.

"£10,000 he's had of the money Auntie Pat left me. He was supposed to be putting the same in himself."

"It sounds as though with your help they might catch him," I said. "Perhaps you will get it back."

"I feel so stupid," she said, "and above all very, very angry. I'll never trust another man again."

She did appear slightly calmer. I hoped for her sake she would recover some of the money though felt this was unlikely.

"Do your mum and dad know about it?" I asked.

"No" she replied, "with dad being ill I didn't want to bother them. They liked Richard such a lot."

She started weeping again. I tried to reassure her that her parents' love would guarantee that they would stand by her, but she was not going to be comforted by this.

"They won't this time," she said, "Not when they know—" and she wasn't able to continue.

At last after what seemed like a very long time, when I was trying to imagine what other dreadful thing could have happened, she said, "I'm pregnant."
CHAPTER ELEVEN

Fatima wanted me to see her neighbour who was apparently senile and not looking after herself. She was so busy now that she had learnt English, and had joined mother and toddler groups plus various activities at the adult education centre. Zora her daughter, now almost two, was joining words together in Iranian and English. I was surprised to see them in the front garden when I stopped the car, but then remembered that it was August so most of her groups would be closed for the summer holiday period. I congratulated her because she was in the early stages of her second pregnancy.

"Sohail working now" she told me. "He's got job in factory. It's not like work he was doing in Iran but he likes other chaps and monies is good with all extra hours he can work".

I was really pleased about this news and to see how well the family had settled on the estate, even to the extent of being concerned about an elderly neighbour.

"She gave £10 to Zora" she said. "I gave it back to her, but boys go to house and she doesn't know what she is doing. Sohail said I must tell someone."

"Does anyone visit her?" I asked. "Like home helps or any relatives?"

"I haven't seen no one only boys but she has animals in back garden."

There was no reply to my knocking at the front door and the doorbell didn't work. There was a tall gate leading round to the back garden, but I was reluctant to open it fearing the animals would be vicious. After rattling it for a few seconds and failing to hear any threatening sounds, I cautiously opened the gate and made my way to the back door.

The small square garden was completely overgrown with grass and assorted weeds. It was separated from Fatima's garden by a high fence, but Fatima and her family needed to use this garden to gain access to theirs by a small gate. I was surprised they hadn't complained before because there was stale food in the garden and an awful stench of drains and decay. Perhaps they mainly used the front door to avoid the problem, and of course Fatima still spent a lot of time at the house where I had first met her. There was no sign of dog faeces nor was there a catty odour, so I wondered what the animals could be.

The old lady was in the kitchen. The window was very grimy, but she appeared to be sitting at the table and was talking to someone who couldn't be seen. There was no response to my knock but the door yielded when it was pushed with some force.

Nobody else was in the kitchen but the old lady was talking to herself very rapidly and the words were complete gibberish. She was thin with very pale skin and sparse wispy grey hair. It was difficult to tell her age but she looked anaemic and ill. The kitchen was worse than Susan's had been when we first met, with about thirty milk bottles, many of them still containing some milk in various stages of decay. There were half eaten cans of food covered in green mould and fungus. My feet stuck to the threadbare carpet and flies were buzzing around my head and face. It was a hot day and the smell was nauseating. I assumed the animals must have died or gone to find a cleaner home.

It was impossible to hold any sort of conversation with the poor lady. She would need urgent referral to Social Services and environmental health, and would almost certainly be taken into a home. I tried to open the door into the next room to see if there were some photos or clues about any family she might have, but I couldn't make it budge. The kitchen had stairs leading from it, but by this time the stench was making me feel quite queasy so I decided not to venture further.

The old lady stopped talking for a moment and closed her eyes. It was then that I heard a scratching sound, so I stood still to see what it was. Two large brown rats were devouring the contents of one of the half eaten tins on the side of the sink, petrified, I watched them with dreadful fascination for what was probably only a split second, then galvanised into action escaped to the security of my car. My heart was pumping loudly and despite the warmth of the day, cold sweat was trickling down my body.

Later when I recounted the story to the appropriate services, the horror was relived. The rats became the size of small cats with beady black eyes and quivering whiskers. Certainly I didn't envy the people who had to sort out the mess.

Standing at the gate of the house with his mouth wide open, showing two rows of pearly white milk teeth beautifully polished was Laura's eldest son. It was the end of the dental project and Ryan, like all the others who had taken part, was anxious to show me that he was cleaning his teeth thoroughly. It did appear that with treats and encouragement the results of the experiment would be very favourable. Ryan knew that today was prize day and he had been waiting in the garden for me to appear. Once he had received his wrapped present he disappeared into the house, but Patrick was not going to be cheated.

"Me one too" he said, tugging at my skirt. Fortunately I had remembered to bring him a little car, anticipating this problem, and he trotted off quite content with the gift.

It was now five months since Laura had been deceived and conned out of her legacy by Richard the imposter. She had completed her first year at teacher training college and passed all her exams, but to people who knew her well it was obvious that she had lost most of the sparkle and zest for life she had once enjoyed. As anticipated her parents were sympathetic and supportive when they learnt about Richard's treachery, but they didn't know about Laura's pregnancy, as she could not bring herself to discuss this with anyone. Laura was eight weeks pregnant when she knew that Richard was not coming back. She couldn't bear to continue carrying the constant reminder of her lover's betrayal, but was torn with guilt because she loved children and had always considered abortion to be wrong. Her doctor made her an appointment with the gynaecologist but there was a two week wait. Technically, the procedure is more difficult as the pregnancy advances, and Laura's emotional state was so fragile that she was having grave difficulties coping with her work at college and the two young boys. Because of all these extenuating circumstances, I went to see the gynaecologist on Laura's behalf, and he agreed to take her in hospital straight away and do the termination. This solved the immediate problem but had probably left her with guilt feelings which she was unwilling to talk about. She had taken the decision not to tell anyone and I could understand that. For the time being her way of coping was to forget that it had ever happened, but I suspected that if she became pregnant again all these buried emotions would rise to the surface.

"I'm fine," she said in answer to my usual enquiry. . "The Police have caught Richard and they say it's likely I may get some of my money back."

"Will you have to give evidence?" I asked.

"I hope not", she said. "They haven't said anything about it."

"Well it will be months if not years before the case comes up," I said. "A lot can happen before then."

"There won't be any more men" she replied adamantly. "I'll never trust anyone again." Privately I felt that this was unlikely but didn't say so.

We talked for a while about the children and her studies at college. It seemed to me that she had put up a barrier and was thinking carefully about what she said, because most of her natural warmth and spontaneity had gone. It would be more than a year before my next scheduled visit to Patrick. She had been given information about counselling services but the issue could not be forced, and who was to say that in the long term her method of pushing the painful things to one side might not work. I sincerely hoped so, but left her with the usual invitation.

"Don't hesitate to call me if you want a visit. I'll always be pleased to come."

There was a "For Sale" notice on Alan and Mary's house which was not altogether surprising. Mary had died in hospital and Helen's sister was still in foster care, though it appeared there were some problems in finding the right home for her. Helen's foster parents had applied to adopt her and Alan wasn't going to contest it. Maybe he was worried about the investigation which would follow, or perhaps he genuinely wasn't interested in her welfare. The reports about Helen were very favourable. She had settled well in her new school, though academically was below average. Emotional deprivation, which she certainly suffered from, can cause both stunted growth and educational underachievement. Helen had grown both taller and heavier since being with the Spencers, but was still short for her age, and though it would never be possible to definitely attribute these things to her abused early childhood it was the most likely cause. The Spencers had recently sent me a school photograph and it was difficult to believe that I was looking at the same little girl who had been found so severely neglected in that dreadful room.

Testing babies' hearing was a notoriously difficult task and was only really accurate when done by electronic methods. Because these were expensive not many Health Authorities were using them, and relied on Health Visitors using a distraction test. I had arranged to meet my colleague at Lisa's house because her nine month old son had failed his first test. The method of testing was for one person to attract the baby's attention forward by using small toys to interest him, whilst he was sitting on his mother's knee and for the other person to make high and low sounds from behind the mother and baby at both sides. There were many problems with this, so it was often necessary to refer for further testing. The babies used to smell the Health Visitor's perfume or perhaps the garlic laced curry she had eaten the night before, so they would quickly turn to the correct side even before the noise has been made by a calibrated machine, which gave the correct frequency and pitch sounds, but had no interest to the baby, who therefore declined to turn. It was possible to use a special rattle and the human voice, but it was highly probable that desperation would cause these sounds to be delivered too loudly.

Lisa's baby boy turned remarkably quickly on that particular day and we were both quite relieved, but just in time we discovered that he was much smarter than either of us. Just behind my colleague who was doing the distraction with a selection of small toys, was a mirror, strategically placed so that the baby could easily see me as I crept from side to side making the high and low sounds. We did manage to get an adequate response after this, which was good news because Lisa had cleared the house of friends and children especially for the event and this was always difficult for her. I didn't ask her about Dean though I knew he was out of prison because he had been seen around the neighbourhood.

Claire had been sick for several weeks, and despite her delight that the fertility treatment had worked, she was feeling too ill to think much about the joys of a new baby.

"I can't seem to keep anything down," she said. "I've lost so much weight that I'm sure it can't be any good for the baby."

She certainly did look ill, though she was dressed immaculately as usual. Her cream and blue cotton dress hung loosely on her normally slim frame. She had probably started the day wearing make up, but the frequent bouts of vomiting had done their worst, leaving her face extremely pale and her eyes dull and sunken.

"You've already had one spell in hospital haven't you?" I said.

"Yes, they put me on a drip and the sickness stopped for a while, but now it seems as bad as ever."

"Well, you're fourteen weeks pregnant now" I said, "When the baby starts to move at sixteen to eighteen weeks the sickness should all stop and they'll take you back in hospital again if they're concerned."

"I just want to know the baby's alright," she said. "It wasn't like this with Adam. Why should it be different this time?"

"You'll be having a scan soon" I said, "and you will be able to see the baby, but I'm sure it will be growing fine. The most likely explanation for your sickness is that you've got an excess of hormones, and though this is bad for you it will make the foetus more viable."

"What causes you to have more hormones with some pregnancies?" she asked.

I didn't give her one reason which was too awful to think about, and surely she couldn't have the terrible misfortune of developing a hydatitiform mole? This is when the pregnancy does not progress normally, and the egg once fertilised grows into a tumour, which produces excessive amounts of the female hormone. Instead I gave her another reason, which would, if true, be shown when she had her scan.

"It could be twins, they produce extra hormones which make you feel ill."

The psychiatrist had no alternative but to section Julie yet again. After her admission to the hospital in February she had enjoyed a period of relative stability, taking her prescribed medication and caring for Katy quite adequately, but in July her parents had come to visit, and perhaps it was the cause of her relapse. Her mother had once again made Julie feel very inadequate, telling her all about how successful her brother and sister were. All Julie wanted was her parents praise and for them to be proud of her, but they didn't seem able to do this, and instead just reinforced how disappointed they were that she wasn't like their other children. In the end, the normally calm well mannered David had been forced to ask them to leave, and they had done so, saying they would never come back again.

There was a long corridor in the adult psychiatric wing, leading to the staff office which was situated at the far end. The hospital was built at the turn of the century, and despite many efforts to modernise it, there was still a very strong feel of institutionalism about the place. The bedrooms were on the left hand side of the corridor. There were some single rooms and others with two or three beds. Most of the room doors were open but no one appeared to be in them. There was a day room on the right hand side and television was on. Several patients were watching it and some appeared to be playing at cards, but there was no sign of Julie. It was very difficult to tell who was staff and who were patients, because the nurses neither wore uniforms or name badges. One or two of the people looked rather strange, but I didn't like to approach any of them as there was no way of telling who they were, and it made me feel rather embarrassed. The next room on the right was clearly the occupational therapy room, there was a hive of activity as the patients and staff were busily engaged in various activities. Julie wasn't there, and once again because I was unsure about the people's identity I didn't speak to anyone.

"I'm pleased you've come" sister said, when I finally reached the office. "We're really at our wits end of how to deal with Julie. We can't give her too much sedation because of the baby, but it means one of my nurses being with her practically all the time."

"I don't suppose there's much chance of me getting through to her either," I said. "When she gets really worked up like this it usually ends in a crisis. Would it be easier for you if she was on the mother and baby unit?"

"We daren't put her there" she replied, "She's completely off babies and we can't be sure she wouldn't end up harming one of them."

Though psychiatry was not my field, I had never seen Julie harm anyone other than herself except the one time she had thrown a glass at the psychiatrist.

"She's been violent towards my nurses too. All she wants to do is get out or harm herself and we're only pleased that she'll be delivering her baby soon."

"I couldn't see her when I walked through?" I said, "Where is she?"

"She'll be in her bedroom, either lying on the bed exhausted before she starts again, or pacing up and down."

Julie was indeed in one of the single rooms with a member of the nursing staff with her. She was striding round and round the small room, still in her nightie and bare feet, though all the other people I had seen were dressed. Her hair was tousled, and her eyes were protruding so much that they appeared to be about to burst from her thin pale face.

"Will you be alright with her if I take a break?" the nurse said hopefully, and I reassured her that there was no problem and I would come and tell her when I was leaving. My only emotion on seeing Julie in this state was of compassion and great sadness, when at a time just before the birth of her second baby she should have been so happy, her severe psychiatric illness was controlling her. Perhaps it was foolish not to be afraid, but she had never been violent towards me. Though there had been very few occasions when I felt really close to Julie, or more to the point when she had allowed me to glimpse a little of the reserved but caring person she could be, I felt we understood each other more than the other many health professionals she had seen.

"Help me, Help me," she implored gripping me as tightly as her large bulge would allow.

"Let's go and sit down" I suggested, and she allowed me to lead her towards the bed and sit beside her.

"What do you want me to do?" I asked.

"I want you to get rid of this," she said, pointing at her stomach.

"But you'll be going into labour soon" I said, "You can't have more than four weeks to go."

"It's not normal" she said, "It's the spawn of the devil. The tentacles are wrapping round inside me and choking me. I must gouge it out, it's going to kill me."

She tried to get up again clutching and tearing at her stomach. The buttons on her nightie had started to come undone, and already fresh red weals were beginning to appear on her swollen abdomen, above the scratches already there. I held both of her hands hoping this wouldn't provoke a reaction, but she was now sobbing noisily and allowed me to lower her onto the bed.

"It's your illness which is making you feel like this," I said. "When they sort out your medication you'll be alright again." I didn't dare mention the baby in case it sparked off the bizarre thoughts again. After this outburst, we did manage to have a little conversation about Katy and David. Katy was in Birmingham with her grandparents, but Julie didn't really show much concern about either of them, except to say again they would be better off without her. I told her that I had to do another visit but would come back later that day. It was difficult to tell whether my visit had done much good, but at least it was another contact from the outside world, as Julie was clearly terrified and seeing things in a distorted way. I wedged the door open fearful of leaving her in such a disturbed state, but fortunately a nurse was just passing and agreed to relieve me. Clearly the psychiatrists were severely restricted in their choice of treatment because of her advanced pregnancy. I felt sorry for the nurses having to look after her in such an agitated condition without any obvious solutions or treatment available, and knew that although I was dreading coming back again, a sense of duty would compel me to.

Sharon now aged three was waiting at the newly installed garden gate. The council had been persuaded to supply the gate, because Shane kept escaping onto the road at every available opportunity.

"Have you come to play those games with the magic glasses?" she said. "I've been waiting ever such a long time."

"I'm really sorry" I said, "I am late, but look I've brought the bag of toys with me."

She followed me into the house where Ken was waiting in the kitchen/living room.

"Susan's had to go to work" he said, "She starts at the shop at four."

Susan now had an evening job at the local general store. She loved meeting all the customers and it fitted in very well with the family, because much to everyone's surprise Ken was now working.

"Are things going well at the factory for you?" I asked him. "How on earth do you manage to get enough sleep with the children?"

"They don't bother me" he replied. "Susan takes them out a lot and once I'm asleep that's it."

Ken had a perfect job as a night watchman at a local large factory. It really suited him because he was on his own and didn't have to make an effort to get on with any colleagues. Susan was still doing her typing course, but in the meantime the income from both their jobs was very useful.

"Let's play with the toys now," said Sharon pulling at my skirt. She had waited quite patiently whilst we chatted, and I was very late for our appointment.

She performed all her three year assessment tests with ease. The combined stimulation of the crêche nursery, plus her mother taking every opportunity to read to the children and involve then in day to day activities, had paid enormous dividends. Sharon was able to chat comprehensively when shown pictures in a book she had never seen before.

Ken had disappeared once the testing had started, but I was able to persuade him to help with the eye test, this was especially necessary because by now Shane was interfering and throwing all the test material about, causing Sharon to be extremely cross with her baby brother. The eye test consisted of matching letters at a distance of ten feet. The room was just big enough and the clutter easily pushed to one side. Sharon could match the letters when shown them close to, but many three year olds can't and have to do the eye test with pictures which is not so accurate. She loved wearing the Mickey Mouse glasses which effectively patched alternate eyes, and passed the test with flying colours.

Ken had talked to me more than ever before, but I knew that there would be no clue today about whether Susan's affair was still on. Hopefully now she was working and the couple had outside interests with not so many worries about money, she would be content to stay with Ken, but this might have been wishful thinking.

Most of the regular activities in the psychiatric wing had stopped for the day when I once again walked down the long corridor. Quite a few people were in the day room watching television and some were already in their own rooms talking to the early evening visitors. I was dreading seeing Julie again and most uncertain of the best way to deal with her in such a volatile state, but I felt sure she wouldn't have any visitors, because it was too early for David, and apart from the priest, her friends at church had temporarily stopped visiting which was understandable.

The room door was open but totally empty. The bed was freshly made and there was no sign of either Julie or any of the nurses.

"Where's Julie?" I asked the sister when finally reaching the staff office.

"She was much worse just after you visited and we had to call the consultant psychiatrist."

I waited for her to tell me more, feeling that she was suggesting Julie's deteriorated mental state was in some way my fault.

"He gave her a different sedation but it wasn't effective, and because of her pregnancy we couldn't use anything stronger. She was so out of control that the baby was probably at risk anyway, so we sent her to maternity for an emergency caesarian section."

"How long ago was that?" I asked.

"Oh, only about five minutes or so" she replied.

I knew that there was no use enquiring about her then, but I left the hospital with a heavy heart. It was likely that the baby would be normal as they are very resilient. There was a slight chance that some of the drugs Julie had been given could have passed into the baby's blood stream, but her medication had been carefully monitored. The future of this family was more uncertain, and short of a miracle occurring, I dreaded what would be its' fate.
CHAPTER TWELVE

Two and a half years had passed since the start of my health visiting career in Saxford. I was now being stopped regularly as I walked through the town, to be told various snippets of information or to be asked for advice. It was often difficult to explain to people that the vaccination and weight control appointment books weren't with me on the weekend trips to the shopping centre, or even out in the country, but though it could at times be slightly annoying, it did show that I had been accepted by the community. On one such occasion, it was almost impossible to recognise Steven the little autistic boy now nearly six. He had been at a specialist school for eighteen months and there was a vast improvement. His parents had needed determination and persistence to get him a place as a boarder in a school in a neighbouring county, but it had proved well worth all their work. The problem of limited resources in the education department was to blame, but I had encouraged Steven's parents to fight for the funds, and seeing such a change in the little boy was proof that all our efforts had not been wasted.

Fatima and Sohail had a second daughter Soraya. Much to everyone's amazement she had been born normally, and Fatima didn't even need to go into hospital prior to her birth as she had with Zora. Because of this uncomplicated birth she was only in hospital for twenty-four hours, and there was of course no shortage of people to assist with her recuperation. She was still spending a lot of time at her parent's home, and it was there I was to make the first visit to the new baby. The midwife had already visited several times, and I approached the house smugly confident that it would not be me this time who would have to drink the sweet liquid and eat the sugary cake assigned to the first visitor outside the family. Unfortunately I had made one fundamental mistake.

The family were all delighted with the new addition. Grandfather who had never learnt English was telling Zora a story in his own language. She was sitting on his knee apparently totally absorbed, but jumped off at my arrival to proudly show me her new sister, switching easily to speaking English. Fatima was sitting on the floor feeding her baby with blissful contentment. She told me that her husband was at work. He rarely seemed to take any time off since he had started at the factory.

Before I had time to take the scales out of the case, the tray arrived with the sweet drink and sugary cake. Valiantly I made an effort to wriggle out of my obligation, because I had come to the house totally unprepared, thinking that the midwife would have fallen foul of this particular custom.

"Nurse Green is diabetic. Sugar very bad." said Fatima, "very lucky for you to be first person again."

Lucky was not the way I would have described it, though somehow the celebration food and drink didn't seem quite so difficult to swallow the second time round now that I knew the family better.

Head lice were on the rampage yet again, and I had lost count of the number of little heads presented for inspection both at surgery and on home visits. The lice were becoming resistant to the nasty smelling lotion, and there was good evidence it wasn't doing the children much good either, but the only alternative was rigorous combing with the nit comb every other day, until such a time as all the tiny black insects had been irradicated. Not surprisingly this was not very popular with the parents, as it was time consuming, but some of the children, particularly the little boys, took great delight in the new sport of bug busting, counting how many came out with each combing. There was a message left at the surgery for me to visit Susan, so I assumed that Shane and Sharon had become infected and took with me some new head lice leaflets designed by the Health Visitors for children, called, "Is Hector head louse hiding in your hair?"

When I arrived at the house there was no sign of activity so I wondered if it would be a wasted visit. However, Susan answered the door. She was alone in the kitchen and was just putting the finishing touches to a sponge birthday cake, piping across the top in red icing "Happy Birthday Ken."

"Ken and Shane are both in bed," she said in answer to my query, "and Sharon's at nursery so I'm taking the chance to do this cake. It's Ken's birthday tomorrow."

This sounded like good news in terms of their relationship, and she must have realised the train of my thoughts because she said.

"I'm staying with Ken, he's stood by me whilst I was ill and he's better with the kids now."

"Well I hope everything works out well for you" I said, "and I'm really pleased that the results of all your hospital follow up tests were so good. You can put the scare of cancer all behind you now."

"Will you give me a reference for an office job in the garage?" she asked. "It's mainly on reception but there's a bit of typing and the hours fit in with Ken's work."

She asked me if I would check her application form, after I had indicated it would be a pleasure to act as a referee, but it wasn't necessary as there were no mistakes to be found. Susan certainly seemed to be much happier, and it wasn't likely that there would be much health visiting contact in the future, as of course she couldn't have any more children.

Alas there were no easy solutions to the problems facing the next family. Social Services had provided funding for several hours of child minding each week, so that Julie would be less stressed, but her mental condition remained unstable.

Katy was having a temper tantrum. Her face was bright red and tears were merging with her nasal secretions which were an aftermath of a recent cold.

"Katy won't do it" she screamed.

Julie was nursing the baby David, now six months. He was a healthy child and had suffered no apparent ill effects from the drugs Julie had been taking prior to his birth. She had spent a month in hospital and seemed to be bonding better with her son than her daughter.

"She won't do anything I tell her. She's spent too long with David's parents. They gave her all that attention and now she's really defiant."

"What is she supposed to be doing?" I asked.

"Picking all those crayons up she's thrown on the floor."

Katy had briefly paused for breath, so I said.

"I bet you can't put more crayons into the box than me. Let's have a race."

Katy began throwing crayons into the box very quickly.

"It's alright for you" Julie said. "You don't have her all the time. She wears you down."

She was of course quite right on both counts, children do wear you down but confrontation is unlikely to produce compliance. The problem was Katy had been cared for by so many different people. She couldn't be expected to make allowances for her mother's mental state, and was likely, as all children do, to play up even more when Julie was feeling worse.

We talked about child management but it was important not to make Julie feel inadequate, because she was already convinced that her family would be much better without her. She was taking her medication and looked quite well, but though she was being given as much help as possible to keep the family together, it was unlikely to be enough and the future still looked gloomy.

The chemist was very full when I called in to collect a prescription for one of my elderly clients but I was pleased to see Laura's mum in the queue. She didn't have either of the grandchildren with her, but Ryan would be at school as Easter was two weeks away, and Patrick presumably was in the crêche at Laura's college.

"How's George?" I asked. The last time I had seen her husband in the surgery he had been very breathless.

"He's having the heart bypass operation next month hopefully, but he's quite cheerful especially now our Laura's happier."

"Oh, I am pleased to hear that" I said, hoping she would tell me more, because as they didn't know about Laura's pregnancy and subsequent termination, it was necessary to tread very carefully.

"She's got a new boyfriend" she went on to say. "George goes fishing with his father, so at least we know the family and something about him."

"Where did she meet him?" I asked.

"He came to mend her central hearing boiler and they hit it off straight away. It's early days yet but let's hope she'll have some luck this time."

I bade her goodbye, sharing these sentiments. Laura was long overdue for some good fortune, and this new affair certainly sounded less complicated than her previous liaisons.

I had been eagerly anticipating the last call of the day, allocating plenty of time for the visit and expecting it to be a joyful one. I was not disappointed.

The proud grandparents were just leaving as I walked up the drive and we chatted for a while as they knew me quite well. Claire was standing at the door carrying a baby on each hip. She was wearing grey trousers and a loose red blouse, because her stomach was not so flat as it had been following Adam's birth, but she looked radiant..

James was the oldest twin and weighed six and a half pounds. Joanna was born ten minutes later weighing six pounds. The birth had been normal, but the first baby was born head first and his sister bottom first. Claire was successfully breast feeding the twins, and managed to do this by sitting on the settee and tucking a baby under each arm.

We undressed them and weighed them, and at eleven days they were both back to their birth weight.

"Who do you think they look like?" she asked.

"James looks like you" I said. He had a lot of dark hair and a heart shaped face with large dark blue eyes which would soon turn brown. "Joanna is obviously more like Simon." She had no hair at all but looked much fairer and her eyes were very pale blue.

"I agree with you" she said, "but we can see a bit of Adam in them both. It's a real bonus to have a boy and a girl because we didn't ask the sexes when I had the scan."

We talked about the monitoring programme for the babies, which would mean weekly visits until a month after the time Adam had died. Because the babies would be having a lot of attention I was anxious for Claire to tell me about her own health. She was having help from her parents but clearly the work involved caring for two babies would be very considerable and enough to make anyone tired. Claire wouldn't admit to any problems and said that she felt really well. The grey smudges underneath her expressive brown eyes indicated that she was probably more tired that she would admit, but her face positively radiated happiness. I couldn't help remembering the vicar's words at Adam's funeral and knew that for Claire her joy had indeed come in the morning.

Simon arrived home from the dental surgery to be greeted with,

"You're early again, the patients will be complaining."

"I can't keep away from you and these two," he said, planting a kiss on his wife and son and daughter.

"The patients will understand."

I left Simon and Claire so wrapped up in their joy. I felt sure there was no other job I would rather do than that of a Health Visitor.

END
ABOUT THE AUTHOR

Christine Sleath was a Hospital Sister for five years and then trained to be a Health Visitor. She worked as a Health Visitor for twenty years and is now retired. She has two children and two grandchildren. She has had professional papers published in scientific journals but this is her first novel.

