Mr Henry Mulligan

Mr Henry Mulligan is a novel which I wrote a few years ago. Long before I became old myself I had great respect and affection for elderly folk. I felt that in hospitals, nursing homes and care homes in particular the older patients were often unappreciated, frequently treated without respect and regarded as subhuman. Too many members of staff regarded the elderly as disposable and irrelevant. (It is, of course, this attitude which made the mass murder of the elderly so easy to arrange in 2020 and 2021.)

And so, for example, it annoyed me when I heard seventy and eighty year olds being addressed by their Christian names, as though they were children or in some way second class citizens.

And because I always tried to talk to my patients, and find out a little about their lives, I knew that no one ever lives an uninteresting life.

Some years ago I wrote a novel about an old man who was dying. His name was Mr Henry Mulligan and he disappeared from the geriatric ward of a large hospital in the English midlands. His wife, who was suffering from Alzheimer’s disease, disappeared with him.

The story is written in the first person and it is based on a true story (though it isn’t, strictly speaking, autobiographical) and the ‘author’ is a young, newly qualified doctor who works in the hospital concerned. He is fond of the couple and when they disappear he decides to try to find them.

His search proves more of a challenge than he had expected and becomes something of a mystery story. The doctor discovers that he didn’t know as much about Mr Henry Mulligan as he thought he did.

Only by uncovering some well hidden secrets can the young doctor find the missing couple and solve the mystery.

It is a fairly short, easy to read novel which I remember I wrote in two weeks in our apartment in Paris. I hardly moved from the keyboard for the whole two weeks and the story pretty much wrote itself. By the time I neared the end of the book, hammering the keyboard as fast as I could to get the story down, tears were pouring down my cheeks. I was, I remember, quite drained when I’d finished it. Here, below, is the Prologue and the first chapter. If you want to find out what happened next then you will, I’m afraid, have to buy the book.

Prologue

Henry had been in hospital for a long time.

We’d first met in the teaching hospital in Birmingham during my finals examination in 1971, a little over a year earlier. He’d only been in hospital a day or so and he had been one of my ‘short cases’. I don’t know how they do it these days but the routine for examining final year medical students was simple and straightforward but nerve-wracking. A visiting examiner, usually a senior consultant from another medical school, took a student to see three patients. Usually these were patients who had been brought into the hospital specially for the day. Sometimes they would be patients who had been recently admitted to the hospital but who had not yet been seen by students.

My ‘long case’ had gone reasonably well and I’d successfully diagnosed the first two of my ‘short cases’. The examiners had been relatively human. Now I just had one more hurdle to overcome. If I acquitted myself reasonably well I would probably pass and mutate, overnight, from medical student to doctor. From reckless and irresponsible to a responsible, respected member of the community in just a few hours.

‘Henry is 72-years-old,’ said the examiner, standing at the end of the bed and rather airily waving a hand in Henry’s direction. At the bottom of the bed, where a clipboard containing the patient’s temperature chart is usually hooked over the bottom rail there was nothing. The clipboard had gone; safely stored in an office somewhere. In its place there was a piece of paper Sellotaped to the bed frame. ‘Henry Mulligan. Aged 72.’ That was all I was getting.

The examiner was Scottish and spoke with a broad accent which I could barely understand. When he waved his arm about, two inches of starched cuff slipped back a little and what looked like, and probably was, a gold Rolex flashed in the sunlight. ‘Without getting closer than the end of the bed I want you to tell me what’s wrong with him.’

I smiled at Henry. I felt embarrassed, partly because of the doctor’s rudeness and partly because of what I was doing. Although I was close to being a doctor I was conscious that I was still a medical student, still not yet thoroughly accustomed to staring at total strangers. I loathed and despised consultants who treated patients with no more respect than they treated histology specimens in the laboratory.

‘The thumb is missing from his left hand,’ I said quickly.

‘Bravo,’ said the examiner. ‘Does it appear to be a recent loss?’

‘No, sir.’

‘Quite right,’ said the examiner. ‘Mr Mulligan lost his thumb when he was sixteen. An industrial accident. It has no relevance to his current stay in hospital and nor, indeed, to your future.’

I studied Mr Mulligan again. ‘He’s not yellow is he?’ I asked. There aren’t many diagnoses which can be made from simply looking at a patient from a distance. Especially when all you have to look at is a face and two hands. Jaundice was an easy and obvious possibility.

The consultant stared at Henry and then at me. ‘No, he’s not,’ he said. ‘But you get no marks for spotting things that he isn’t.’ He sounded bored. ‘If you’re going to give me a list of things he’s not then we’re going to be here a very long time. To save us both time, he’s not pregnant, he hasn’t got measles and he’s not dead either.’ He smiled and displayed two rows of perfectly capped and polished teeth. He looked like a shark. ‘I’m not always this helpful,’ he said. ‘You must be charming me.’

Now I knew. The consultant was one of the sarcastic ones. I felt the sweat breaking out on my brow and wondered whether it would be better to leave it there or to wipe it away. I stared at Henry again. All I could see of him was his face, neck and hands. It really wasn’t a lot on which to form a diagnosis. Six years learning seemed to have disappeared as quickly as water down a drain. ‘Does he have any symptoms?’ I asked the consultant.

‘He may do. Indeed, I would go so far as to say that it is extremely likely. Despite the generosity of the health service I doubt if he would be taking up a bed if he had no symptoms. This is not my hospital but I doubt if your superiors will have stocked their beds with healthy passers-by taken from the streets. Your task here is to make a diagnosis simply by standing where you are and using your eyes and whatever cerebral tissue the good Lord chose to give you.’

I stared again. Henry’s hands and wrists seemed normal. No signs of arthritis. No Dupuytren’s contracture. No clubbing. No skin lesions. His hair was thinning but baldness would hardly be the diagnosis the inquisitor was looking for. Both eyes seemed normal. Pupils the same size. Or were they? Was one a little smaller than the other? He had dark brown eyes and from this distance it wasn’t easy to be sure. One eyelid seemed to be drooping a little. Did he have a seventh facial nerve paralysis? Henry, staring back at me, allowed a twitch of a smile. The corners of both sides of his mouth moved together. No seventh nerve paralysis. No Bell’s Palsy.

‘His breathing seems a little laboured,’ I said, rather desperately.

‘So is yours,’ sneered the consultant immediately. ‘But it’s hardly a diagnosis, is it?’ He looked at his watch, lifted it closer to his ear and shook it as though wondering if it had stopped. Some consultants develop these little bits of play acting. They think they’re being funny.

I stared at the patient again. There was some redness on the man’s cheeks. It wasn’t a lot. Hardly there really. And I was certain there was some drooping to one eyelid. The right one.

Just then the ward sister approached. She was carrying a small piece of folded paper.

‘I’m sorry to bother you, sir,’ I heard her whisper. She oozed deference and ingratiation. ‘There’s a telephone message for you.’

I was still staring at Henry. He lifted a finger and touched his cheek. Then he touched his right eyelid. The movement looked perfectly natural. But I knew it wasn’t. Some patients have been known to give students a clue. Maybe these were clues. On other hand some patients have been known to deliberately mislead students.

The examiner had opened the note and was reading it.

I was sure now that Henry’s cheeks were slightly red. And there was a slight droop to one eyelid. If only I could see the pupil a little better. I glanced at the ward clock. I had less than two minutes to make a stab at a diagnosis. But what the hell was it? Patients with a type of heart disease known as mitral stenosis will sometimes have very red cheeks. It’s not common. I’d never seen it. But if teaching hospitals specialise in anything it is the rare and unusual.

A drooping eyelid can be a sign of many things but it can be part of something called Horner’s Syndrome: a possible sign of lung cancer.

The trouble was that I now had two quite separate diagnoses. One diagnosis would be good. Two was twice as many as I needed. But Mr Mulligan had definitely touched both his cheek and his eyelid. If he had been giving me a hint he had been giving me two hints. Two clues.

The examiner folded the note and slipped it into his jacket pocket. ‘Thank you sister,’ he murmured. The sister paused for a moment, as though wondering whether she should curtsey, and then backed away down the ward. ‘Are we any closer to a diagnosis?’ he asked me.

I thought hard. My brain was racing and sweat was dripping into my eyes. Underneath my white coat my shirt was soaked and clinging to my back. I had two possible diagnoses. But which one should I choose? I had been taught that I should always try to fit a patient’s signs and symptoms into a single diagnosis. But I knew of nothing that could cause reddened cheeks and a droopy eyelid.

‘I suspect that Mr Mulligan has two problems,’ I said softly, taking my future by the throat. I had turned away from the patient’s bed. I felt uncomfortable about announcing my diagnosis in front of him, though I knew that he would already have been told what was wrong with him and warned to ignore the diagnostic ravings of medical students. ‘He has mitral stenosis and pulmonary carcinoma.’

‘You suspect?’ said the examiner. He glowered at me. There was no sign on his face as to whether I was correct. ‘The verb ‘suspect’ is a very uncertain word. I don’t like uncertain doctors.’

‘Mr Mulligan has mitral stenosis and pulmonary carcinoma,’ I whispered.

‘Two diagnoses?’ said the examiner. ‘You have one patient but you’re giving me two diagnoses?’

I nodded. If I failed I would have to spend another year at medical school and then resit my finals in twelve months’ time. I had heard of students who had failed their finals three times.

‘Do you have a Guardian Angel whispering in your ear?’

‘No, sir.’ ‘Do you believe in miracles?’

‘Possibly, sir.’

‘Well I certainly do now,’ said the examiner. Another little joke. ‘You’re absolutely right. Mr Mulligan has mitral facies caused by mitral stenosis and he has developed Horner’s syndrome as a result of developing pulmonary cancer.’ ‘Thank you, sir,’ I murmured.

‘Nothing whatsoever to thank me for, doctor,’ said the examiner. ‘Congratulations.’

Before his words had properly sunk in he had turned and was walking away, heading for the sister’s office and the telephone. Abandoned, I stood at the end of Henry’s bed. Two words had changed my future. Doctor. Congratulations. It was over. I had qualified.

Still in a daze, I thanked Mr Mulligan and shook his hand. He smiled and congratulated me. I was still too traumatised to take it in. I left the ward, went to the hospital canteen and celebrated with a cup of weak coffee and a stale doughnut.

Chapter 1

Twelve months later I was finishing my pre-registration year’s work as a junior hospital doctor and Henry was still a patient in the hospital where I had first met him. I was working on the male geriatric ward as the resident junior doctor (the doctor on the very bottom rung of the hospital hierarchical ladder, the one who gets up in the middle of the night, appears on Sunday afternoon when a new patient has to be admitted and turns up at odd hours of the day and night to take blood samples, deal with day-to-day emergencies and, in view of my height, fit fresh light bulbs into the fitting in the ward sister’s office). Henry, who had been thrown out of the acute medical ward because they could no longer think of anything positive to do with him, was a patient there. He wasn’t well enough to go home. He wouldn’t have been well enough to go home without full-time nursing care. Since he lived in a caravan with a wife who was ill, he stayed in hospital.

We were both on Windom ward because it was a place for people who weren’t wanted anywhere else. Henry wasn’t wanted anywhere else because he was considerable incurable; beyond medical redemption. Patients died every day on Windom ward. It was what people seemed to do best there. It was certainly what they were expected to do. Patients were dumped on the ward because there wasn’t anything else that could be done for them and they weren’t well enough to go home or be deposited in an old people’s home. I was there because I’d annoyed too many important people to get a job on a fashionable ward where exciting things were happening. Over my years as a medical student I had found a number of ways of upsetting the establishment hierarchy. Putting me on Windom ward was, in their eyes, a punishment.

But even though we had ended up in the same place because we weren’t wanted anywhere else (or considered good enough to be anywhere else) my future was still considerably brighter than Henry’s. I was about to become a fully registered medical practitioner, entitled to escape from the hospital and work as a general practitioner without supervision. Henry had a big T stamped on his medical notes in red ink. He was terminally ill and the consultant responsible for his destiny had decreed that if there was an emergency Henry was not to be resuscitated. No one thought he was worth bothering about. He was old and unimportant. He wasn’t, and never had been as far as anyone knew, a man of significance or substance. He was just another dull, old man waiting to die. So, why bother doing anything to delay the inevitable? No one would dare admit it but that was the official policy. Of course, if he’d ever been important, or related to someone important, things would have been different.

During the twelve months we had known each other, Henry Mulligan and I had become good friends. I sometimes wondered if I would have qualified without the confidence he had given me. That touch on his cheek and the touch on his eyelid hadn’t given me the answers but they had given me the confidence without which I would once again be standing there sweating while an impatient examiner stood behind me shaking his watch. I felt a great debt to him but there was far more to our relationship than that. I had learned more about real life and about people from Henry than I had learned from any doctor or teacher. Often, at night, we would talk in the day room. He didn’t sleep well and he would sit there, in his wheelchair, reading quietly: a solitary and lonely figure, lit by the light from a single wall lamp. If I was called to the ward I would call in to see how he was and I would end up sitting and talking. Or, rather, sitting and listening.

It was difficult for him to talk. His deteriorating heart and his lung cancer meant that every breath was an effort, and every word had to be hewn out of what little strength he had left. It meant that he weighed his words with special care and laid them before me with the caution and precision of a poet.

He told me something about his life. His parents had been poor. His father had worked on the dustcarts and hadn’t learned to read until he was 26. He’d taught himself so that he could make sure that his son wouldn’t have an illiterate father. His mother had cleaned office floors at night. They had both worked until they’d died. ‘Kind, honest, decent people. Salt of the earth,’ was how Henry described them. ‘Exploited’ he added, the bitterness showing through.

Henry’s formal education had ended when he’d left school at 14. He had worked as an apprentice at a small engineering factory in the West Midlands. Wolverhampton. Willenhall. Wednesbury. Walsall. Somewhere in that area. At nights he’d studied maths and engineering as part of his apprenticeship but, with an unquenchable thirst for knowledge, he’d also studied English (language and literature) and History.

‘When I was a teenager I believed that the truth would set us free,’ he said, wistfully. ‘But the innocent days didn’t last long. The more I discovered the more discontented I became. The truth does not make us free but it does make us angry, frustrated and bitter. It makes us conscious of our own impotence and of the extent of the evil which surrounds us.’

***
I got into the habit of taking a flask of hot water, two mugs and some Earl Grey teabags into the hospital with me. Henry loved a cup of tea but hated the stuff the hospital served up. ‘It’s brown and milky and doesn’t taste of anything,’ he complained.

We were drinking tea at six o’clock one morning in the day room. The night staff were still on duty and breakfast was still an hour or so away. Henry couldn’t sleep, as usual, and I didn’t see any point in going back to bed. I had a patient who was seriously ill. I knew I would have to go and see him in half an hour so I sat with Henry.

‘My father was in this hospital just before he died,’ said Henry. ‘In fact he died here, though not on this ward. When my father was dying he said something that, at the time, I thought was very sad,’ said Henry. ‘He said that there was no-one in the world who called him by his first name. All his friends and workmates were dead or too sick to visit him. My mother had gone years before. All his relatives were either dead or out of touch. The only people he saw were the nurses and the doctors, who all called him Mr Mulligan, and me. And I called him Dad.’

Henry sipped at his tea. ‘He wanted me to call him by his Christian name. He was Henry too. But I couldn’t bring myself to do it. It didn’t seem right. I know kids do it these days but back then it seemed like blasphemy.’

‘So, what did you do?’

‘I had a word with the doctor and got the doctor to call him Henry.’

I smiled at him. ‘Did your father enjoy that?’

‘Very much,’ nodded Henry. ‘He didn’t know I’d arranged it and he told me about it with great glee.’

‘That’s a nice story,’ I told him.

‘But it’s only half the story,’ said Henry. He sipped again at his tea. He always sipped at his tea, like a man drinking a fine malt whisky. ‘Do you know I can’t remember when anyone called me Mr Mulligan.’

I looked at him, frowning. I didn’t quite understand.

‘Everyone I meet calls me Henry,’ he said. ‘Every doctor, every nurse, every porter, every cleaner, every clerk – they all call me Henry.’ He waved a hand. ‘I go down to the X-ray department and the girl at the desk calls me Henry. The radiographer calls me Henry. The porter who brings me back calls me Henry. I go down to the lab and the technicians call me Henry. Oh, I know it’s not just me. They do it to everyone. They call all the patients by their Christian name. They all call one another by their Christian names too.’ He paused and stared at his tea. ‘There’s no dignity to it. There isn’t the joy of reaching that moment in a relationship between two people when formality is dropped and people get on first name terms. That’s what it used to be called. Being on first name terms. It meant that you knew one another well and that you were friends rather than just acquaintances.’

I didn’t know what to say. I was as guilty as everyone else and I saw his point. I knew he was right.

We sat in silence, the weak, morning sunlight slowly filtering in through the day room windows.

‘Would you like more tea, Mr Mulligan?’ I asked him at last.

He looked at me, saw that I was serious, and held out his cup. ‘Thank you doctor,’ he said. ‘That’s very kind of you. I don’t mind if I do.’

I filled his cup and then filled mine and put the now empty flask down on the table in front of us. We sat there, sipping at our tea and watching the day break.

***

After that I addressed Henry as Mr Mulligan and I addressed his wife Daphne as Mrs Mulligan. Henry, in turn, addressed me as doctor. Daphne could hardly ever remember my name but when she did it was still my Christian name, which I didn’t mind a bit.

More importantly, I always referred to Henry as Mr Mulligan when I was talking about him to other members of the hospital staff. And the funny thing is that it stuck with quite a lot of them. Nurses and porters and even other doctors referred to him as Mr Mulligan and called him Mr Mulligan when they spoke to him. And then I did the same thing with other patients too. Instead of referring to them by their Christian names I referred to them by their surnames.

***

A week or two later we were sitting in the day room drinking tea. I can’t remember what we were talking about.

‘Would you like more tea, Mr Mulligan?’ I asked him, holding up the flask. ‘There’s still a cup each left.’

‘Do you know,’ he said, looking at me. ‘I think we know each other well enough to dispense with the formalities. Why don’t we address each other by our Christian names?’

‘On first name terms?’

‘On first name terms.’

I thought about it for a moment. ‘On one condition,’ I said at last. ‘Only when we’re alone. When we’re with other people – or when we are talking about each other to other people – we stick to surnames. You’re still Mr Mulligan.’

Henry didn’t even think about it. He held out a hand. I put down the flask and grasped it.

‘It’s a deal,’ he said. ‘A gentleman’s agreement.’

‘And today we celebrate,’ said Henry. He took a small miniature whisky bottle out of one dressing gown pocket and two bars of chocolate from the other.

‘What are we celebrating?’

‘Every day from now on is a bonus,’ said Henry. ‘It was exactly six months ago that my consultant gave me six months to live.’

‘So you should be dead by now?’

‘Exactly.’ ‘You look well for dead.’

‘I feel well for dead.’

‘Doctors shouldn’t make prognoses like that,’ I said.

‘They shouldn’t,’ said Henry. ‘I hope you never will. Doctors can kill people that way.’

I took a bite from the bar of chocolate he’d given me and waited.

‘Since I’ve been in here,’ he said, ‘I’ve known three people who’ve died because they were told they were dying.’

‘You can’t know that,’ I protested.

He shrugged. ‘Pretty certain of it,’ he said. ‘They were all told by their consultant that they would be dead within a specific time period. Same chap who told me when I’d die. They all fretted about it. They all regarded the date as though it was an execution date.’

‘And they died near to it?’

‘No. They died on it. Bang on the button.’

I ate more chocolate and felt a shiver down my spine.

‘Voodoo,’ said Henry. ‘Plain, old-fashioned voodoo. If you live in a primitive village and the man in the warpaint and chicken feathers tells you that you’re going to die then you die. Here we’re a bit more sophisticated. The man handing out the death sentences wears a white coat instead of warpaint and chicken feathers.’