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Michael Cox's memoir about his life and work as a country doctor in Caldbeck, Cumbria, in the north of England (which spanned the years from 1949 to 1983) has an immediacy that reveals his responsiveness to the needs of his patients and his humanity. His compelling writing style allows us to witness his reverence for their hard lives, their dignity. The influence of Florence Nightingale can be detected in this work for he trained at St Thomas's Hospital in London where Nightingale established the first ever school of nursing. He married a Nightingale nurse who trained there under the supervision of one of Nightingale's students. His wife, Betty, was an integral part of his country practice. We discover Cox's pragmatic solutions to clinical problems as he treats serious accident victims from the mines, cantankerous villagers who do not entirely believe in medical intervention for life's ills, and sheep farmers and their families who tend to treat themselves long before summoning the doctor. But it is his afterword that captures the essence of his memoir. He has said that "(he) realizes how much of (his) own work and life was spent supervising the course of illnesses and conditions and how seldom one altered the outcome. Most of them got better whatever one did and, especially in the early days, the fatal ones progressed whilst one tried to alleviate the symptoms. At the best one probably helped patients and their families through their various crises. There were some for whom one could not even do that."1(p139)


It was a winter's evening when I was called to a cottage in the village. It had been empty for some time and I did not know that it had been rented, neither did I know the young couple there. They were from a town and the house was scarcely furnished, a mattress on the floor with bedding, some boxes, and probably a chair or two, with the window covered with a piece of cloth pinned across it. They were thin, pale, and looked as if more money was spent on cigarettes than on food. She was on the mattress staring at a newborn, very premature baby, she thought about 26-28 weeks gestation but had no true idea of her dates. It was tiny, still attached to the placenta, and was struggling with little short intermittent breaths. All I could do was to separate the placenta, tell the man where the nurse lived and send him for her, stuff the little baby, still covered with blood and mucous inside my shirt front for warmth and drive with it to the maternity hospital fourteen miles away over the hill.


Of all the usually so kind and caring midwives that I knew, the grumpy one was on duty. She had probably had a bad day, for when I produced the poor little thing from my shirt she said flatly "That's not a baby, that's an abortion." She was probably right but I found it upsetting. Although tiny, the baby was perfect and during the journey I suppose that I had come a little way to bonding with it. However, there being no other infant life support equipment those days, all we could do was to put it in an incubator and try to keep its airway clear.


There we watched her slowly die.


The journey back was sad. There was the thought of telling her parents, rain on the windscreen turning to wet snow, but not enough of it to lie and look pretty. No moon, no stars.


The couple took their loss with the flat lack of emotion of those for whom nothing has gone right, I felt that it was just one more knock in a life full of failures.


After making sure that the mother was alright and saying that I would call in the morning, I went home, changed my shirt and finished what was left of my Christmas dinner. The next morning, when I called, they were gone in their old van and I never saw them again.1(p139-140)


Dr Cox's distress is almost palpable. He is saddened for the lonely couple and their stark lives. His heart aches for the diminutive baby girl he holds inside his shirt for warmth. And he is wounded by the harsh words of the fatalistic midwife. When he gives the parents the news of their loss, he feels their hopelessness. What makes this story worth telling? And why must we share our own experiences that echo this Christmas night in Cumbria? It is the very real fact that in the midst of such dismal circumstances, there was reverence for life. And reverence for life is the antidote to fatalism and despair.




1. Cox, MI. Country practice. Critical Moments. Indianapolis: Author's House; 2003. [Context Link]