The French Village Doctor

Jacques Lepoutre had planned carefully. As he drove on the quiet road three kilometres out of his village into rough garrigue country, he mused dreamily. The midnight-blue Renault “Onze” hummed along the narrow road flanked by plane trees and fields of crinkly vines in the direction of Verhan, a mediaeval village of 300 people in the Languedoc region, South of France. It was November – the colours of the vines were rape yellow, wine red and flaming orange. It was mild but the sky was heavy and grey. Jacques always liked autumn after the grape picking, the “vendanges”, when the huge blue Braud machines shook the bunches off. He had often sweated over vines out this way where he had two parcels of land. He was heading to one of them now. His wife and two daughters were asleep in the back. He smiled at their peacefulness. Usually, they would be all excited with noise and bickering.

The track off the road was dusty and potholed, but the old car’s solid suspension cushioned the bumps. He came to the chosen spot in dark shade under a fig tree. He was relaxed. The pills he had swallowed were strong prescription tranquillisers and he had timed the arrival to coincide with their taking effect. His wife and daughters slept on in their own drug-induced comas, having been given the sleeping potions well before departure.

He doused the car with petrol all over and inside, watching the liquid soak into his younger daughter’s pink tracksuit. He clambered back into the car and sat vaguely appreciating some pale light through the gauze of grey over the craggy rocks on the hilltop. He locked the doors and swallowed the rest of the drugs acquired for his chronic depression.

Before his next irrevocable move there was an instant of clarity as if he experienced normality for the first time in many years – all was calm, no crazy voices in his head, no agony; there was even some future sunlight, but there was no going back. Blackness buried him again. One last look at the vines, one glance back at his family, one click of his “briquet” lighter and there was a crackling conflagration that soon caused the full gas tank to explode.

Vintners in the fields and various villagers said later they heard the “whoomp” like a jet breaking the sound barrier, overwhelming the usual rustic cacophony of crickets, cicadas and barking hunting dogs, but everyone took it for the frequent thunder that rolled around the hills at this time of year.

Louis Lottisse, a doctor in the tiny village of Roseanne, was out for his routine pre- breakfast jog. He noted a burst of light in the distance not unlike a flash of autumn colour among the vines, but paid no attention as he concentrated on his run.

It had been a bad morning. His wife had rushed off without making his usual “petit déjeuner” – a slice of fresh melon, a “tartine” and his favourite coffee, Grand`mere Dégustation Pur Arabica. It took 15 minutes to prepare. Melon was more usually eaten before dinner, soaked with sweet Muscat, popular in the South of France, but Lottisse had developed a taste for it with breakfast after one of his Brit patients had recommended it. Lottisse thought if it was good enough for the “Breeteesh” it was surely good enough for him. Then he couldn’t find his favourite jeans. In the Midi heat, it was all right for doctors to dress down more comfortably. Anyway, Lottisse had been Down Under, to “Nouvelle Zélande”, and had been impressed by the casual ways, even business people in shorts and dress socks. Louis wondered what else would happen this morning to upset him before his day’s patients.

As Louis was musing over his melon, an old vintner was cycling from his home to his land. He nearly fell off his bike when he saw the black shell of the Renault and peeped in on its charred occupants. He had no cellphone, having no need to call home while tending his vines, so he cycled to Roseanne to tell the “gendarmes”. They did not leap into action despite the old village character muttering about bodies. They were used to over-dramatisations by locals and knew that taking it easy was best. Anyway, car burnings were commonplace in France, some 30,000 cars a year set alight. They would have a look after lunch. The old winemaker bade them farewell, not bothering to say anymore about his discovery, knowing wisely it was useless to try to persuade the immovable. His duty done, he cycled back to his vines.

Louis had a visceral dislike for ordinary life, although he knew he would always return to the humdrum village of Roseanne, his birthplace. The trick for Louis was making it interesting within quotidien constraints. Perhaps this need for something more socially pizzazzy was the reason he had developed a perverse style of relating to patients and a carefree adoption of the cavalier French way of over-prescribing – it was all a bit of fun really, and it helped the local pharmacy.

He had a premonition it was to be one of those days, one of those surgeries, as he hastened across the courtyard of his inherited mansion – his father had been a big vineyard owner – to his waiting patients. He could sense there would be a foreigner or two, their paltry French stretching his broken English. He usually just joked his way around it all, unworried about the chance of terrible misunderstandings leading to bizarre diagnoses and unfortunate mistreatments – not really a problem for Lottisse because he had perfected the way of many French doctors in the early 1990s by dishing out gargantuan prescriptions. This neatly covered the hazards of having to relate, having to learn about their foreign maladies and often conducting it all in English. Why they came and lived here with their abysmal French was beyond him. In truth, he occasionally felt sorry for them having to learn to live in a new place and get by on school French. He didn’t realise they were as happy as vintners in vats, life so much better with the sunshine, fresh market food and high-quality local wine. Louis liked them though as they were a change from the usual villagers and their ailments, such as the ends of their fingers lopped off by electric secateurs or sickness caused by the chemical spraying of the vines.

The rest of the morning no-one else passed the Renault, and no-one reported anything to the police. It was nearly lunchtime, nothing much happening, so the sergeant and his sidekick locked up early and headed for their respective homes, shouting farewells and see you about two o’clock, and remember we’ve got to go and investigate a burned-out car. Yes, probably young fellows from the town 12 kilometres away, or the city 25 kilometres distant. “Bon appétit!” said the sergeant.

Lottisse was a hands-off doctor. Some old doctors would say power to him, recognising ailments and prescribing accordingly. Experienced physicians did a lot of touching and feeling, comparing signals from the fingertips with a template in their mind of what was normal. Another thing about Lottisse, he was all right with blood – he could look at it in all its shapes and forms, gushing forth or setting solid. Some doctors can’t stand the sight. Lottisse’s characteristic was he didn’t like touching people, bit of a drawback for a person whose job is connected with the laying on of hands, so to speak. A patient would come in with an itchy bum (Lottisse knew it as “pruritus ani”), and he would write out a prescription for several items, no need to look at the posterior. Another patient would complain of lumps in his neck, not the hurting kind, just hard things like cysts; Lottisse would look at the offending bumps aloofly from a metre away and brusquely declare, “All good! They’re mosquito bites you’ve scratched and made septic. Here’s a line for some ointment and pills.”

There were patients who swore by Lottisse … a few swore at him, too! His supporters mentioned in glowing terms how he would rush to their bedsides in their homes and treat them with great kindness, perhaps the travel affecting his behaviour. Also maybe Lottisse thinking patients in his surgery were a bit hypochondriacal; those calling him out were clearly in total need of his speedy and undivided attention, those able to make the trip not so needy. Then there were his patients who loved him for his cherished advice on drinking wine. Not everyone, of course. He had a British wowser who told him his advice was commercial self-interest because he was recommending quantities of wine, such as a litre a day.

“A bottle a day keeps me away!” Lottisse would say. “Yeh, well away!” the wowser would say unkindly.

Lottisse waved him aside saying the Brit was probably from one of these places that had no fun in life, that was fearful of immoderation and told people that a dull couple of glasses a day was the wise amount. Lottisse himself thought nothing of a couple of bottles. Two or three glasses at lunchtime, then any amount over a long dinner. That’s more like it, that’s living, “C’est la vie! Bonne santé!” Lottisse would say to everyone. Doctors, like all serious professionals, tended to hold a sense of importance being clever lads at school, then getting a specialised knowledge over many years, finally acquiring or receiving a status accorded by others, especially in a small community. In truth, they deserved every bit of the reverence, anything to compensate for the tedium of treating coughs, colds, chickenpox and the clap. Lottisse enjoyed the reverence for his profession, carrying its status label to eccentric lengths.

Gavin, a Kiwi, had lived over 20 years in the area. He had been Gav back home, but rather liked being called “Gaveng” in the strong Languedoc accent. He had visited Dr Lottisse many times – and had been visited by him, of course! – for various health problems, trivial and serious. The small complaints had involved ear-ache and a skin condition. Lottisse had looked inside his ear and for the latter malady had prescribed soothing cream. Gavin had more serious problems to do with his work and his lifestyle. He travelled a lot as a wine sales rep, socialised a lot, imbibed litres of the local reds and certainly smoked too much. So when his heart started to race one night and he began sweating, Lottisse raced to his bedside. Later, he was grateful that the doctor had kindly driven him 30 minutes to the city hospital. And there was another life-saving time to do with prostate cancer, Lottisse making sure he received the best attention, treatment that the French medical system was capable of. So he didn’t have a bad word to say about him, the best doctor he’d ever met.

Gavin invited comments about Lottisse’s strange ways when he recounted to people the following little tale. He had gone to the surgery one day with an ingrown toenail, something causing him so much pain he could hardly walk. He limped into the doctor’s room and Lottisse told him the foot would have to be amputated. When he saw the look on Gavin’s face, he burst out laughing. He prescribed pain killers, bandages and cream – there was no need to look at the offending toe, of course.

Clearly audible in the waiting room that day, Mick Jagger was singing “Sympathy for the Devil”. Gavin said he loved the Stones and had seen them in concert several times. Louis said he was crazy about all British rock music and asked his patient if he’d like to see his collection of LPs, lovingly gathered over 25 years. Gavin said that would be very nice, thinking another time. No, the doctor meant right there and then – it didn’t matter that people were in his waiting room! It was not to be missed, a Rock’n’Roll moment! Anyway, the other patients would be enjoying the great music in the waiting room. Louis said a good dose of music from the Stones was therapeutic for sick people, quite calming, taking their minds off their ailments. Louis and Gavin crossed the courtyard and went into the doctor’s huge ivy-mantled house. Gavin was admitted to his special room full of Rock’n’Roll memorabilia. Within minutes they were both rocking and rolling to the thunderous beat of “Street Fightin’ Man”, Gavin’s limping condition miraculously forgotten by both patient and doctor. Later, Gavin wondered if the next patient would have noticed that Lottisse was sweating profusely on his return.

Not everyone was a fan of Dr Lottisse though. There was an English woman who entered his surgery and he said, “Not a woman’s problem, is it?” She looked shocked. He continued blithely, “You’re pregnant, aren’t you?” as if the first statement and the second were connected. Through gritted teeth after a baleful stare she told him she wanted him to examine her ankle which she thought she’d sprained. Lottisse never turned a hair, merely asking her to indicate the affected area, then he visually assessed that it required ointments and dressings. He didn’t once touch the ankle – it was the beginning of serious rights for women, and he had no desire to risk anything. To mollify her he wrote a long prescription, but she said she would never return.

The two policemen, burping with satisfaction after their three-course home- cooked lunches, headed out of Roseanne about 2:30. They were in no hurry, taking in the autumn colours as they went. They had a stop or two along the way, someone they knew, a good ten-minute chinwag, and one of them needed to relieve himself of his lunchtime three glasses of local red, bulk wine so easily quaffed.

Louis Lottisse had almost finished his afternoon patients. The last one was Torquil, a Scottish doctor now living in Brisbane, Australia. He was on holiday for a couple of weeks in the South of France staying with an old friend. Soon after he arrived he got a sore throat and felt very tired, possibly a combo of jetlag and a fair bit of the local wine to celebrate his visit – there was also diarrhoeia. He decided that some drugs were needed as the condition intensified, medication to help him have a holiday. This would involve going to a doctor, which he didn’t look forward to because of his lack of French. Perhaps the doctor would have some English. He doubted it. Not too many doctors in Australia speaking French! And he knew French people were reluctant to speak English.

So Torquil took himself to the doctor’s in warmth and sunshine, conditions in which Doc Louis would rather have been swimming in the Mediterranean. He glimpsed the good doctor for the first time after he had been in the waiting room about ten minutes. Louis popped his head round the door to say “bonjour” to about six prospective patients. Torquil thought his manner a tad too blithe for comfort but let it go, a regional mannerism perhaps. Dr Lottisse noticed that the temperature of the room was not good, the aircondition machine being off. He stepped in to switch it on, apologising for invading the privacy of his patients as if it was odd that he was mixing with his patients almost socially, far less strange switching on the aircon. There was something touching in his manner, a shyness underneath the flickering smile, as his patients nodded their gratitude for medical connection and the first comfort dispensed by the doctor.

He then turned, went to the doorway, paused, turned back, leaned in and put his hand behind his ear listening … Oh, no music! He rushed off to fix the volume. His first patient was called a few minutes later to Peter Sarstedt singing: “Where do you go to my lovely, when you’re alone in your room?”

Torquil waited over 45 minutes for his turn. He had decided rightly or wrongly that he would not tell Dr Lottisse that he was a fellow medico, albeit not a frontline general practitioner but a highly regarded private psychiatrist. Many years before, he had served long and hard as a GP back home in Scotland before moving to Australia.

Why he had decided not to tell Lottisse that he was in the same game he could not recall later, but it had to do with the language difficulty – perhaps least said, soonest understood. Or he sensed that Lottisse would like to exercise his English, thinking he was with an ordinary member of the public rather than a fellow professional.

Anyway, Torquil knew he had an “urti”, an Ozzie contraction for upper respiratory tract infection, and expected that even a foreign doctor would be able to diagnose this quickly and jot a prescription for what he had mentally self-prescribed already: some antibiotics and a bottle of cough juice. He wouldn’t mention the loose bowels, a condition he’d had all his life, thankfully not extending to verbal diarrhoeia. He also wouldn’t tell the doctor what he had self-diagnosed, knowing that doctors like to do that by themselves. He mused over the saying that a doctor who tries to treat himself has a fool for a patient, but part of the treating surely was simply going to a doctor. No time now for such niceties of thinking. Torquil went in to see Doc Lottisse to the strains of “Jumpin’ Jack Flash”, making a mental note to try playing some suitable music in his own consultancy on the 15th floor of a Brisbane high-rise. Probably not the Rolling Stones, although Start Me Up, The Last Time and Dear Doctor would be apt.

“Asseyez-vous, monsieur, s’il vous plaît. Et le problème?” asked a suitably professional Lottisse, flapping his hand up and down like a fish tail on the brown- rubber-covered couch. Torquil levered himself up on to it, so that doctor and patient were almost on the same level, one standing, the other sitting. It caused Torquil to feel as if he was a seven-year-old, a not unpleasant experience, but it did help him to to keep quiet about being a medical specialist with fifteen years more experience than Doc Louis. Torquil pointed to his throat, making a hand movement not unlike the doctor’s couch gesture. He muttered, “All stuffed up, a lot of nasty goo.” Lottisse looked inside his throat, eyed the outside of his neck with a practised curiosity, asked him to “avaler”, doing exaggerated swallowing motions himself. Torquil imitated with some difficulty and obvious pain, then went into a coughing fit, and indicated in as dignified a way as possible his need to spit out. Lottisse gave him a stainless steel pan and looked away muttering “dégalas”, or disgusting, probably feeling safe using street lingo because he had sussed that Torquil knew no French.

There was no touching the inflamed throat and glands at all – well, a sort of touching if you allow gently patting for a few seconds with fingers brushing like feathers. Now Torquil began to wish that he had put himself on a sounder professional footing with Lottisse. He continued the “examination” by taking Torquil’s “tension”, declaring his blood pressure high which would explain the nose bleeding. Doc Louis said the pressure should be lowered, so he started to write on his prescription pad. The first thing would be cortisone with a diuretic. Torquil nodded approvingly, something he wanted. Then Lottisse consulted a huge and much- thumbed manual, all the while whistling jauntily as he scrawled on the pad. Torquil got a strong impression of someone acting as if he were a king, regally waving his sceptre over a document to pass a decree.

Finishing whistling he asked Torquil to pay 22 Euros for his services, a small amount Torquil thought, considering his Brisbane patients paid ten times as much for half an hour of his expertise. The odd thing was that Lottisse should handle the money himself, as if it was a “pourboire”, a tip going in his back pocket. Of course, it was simply because there was no receptionist, but still strange that the doctor should be combining his noble services with the rather lesser one of taking filthy lucre. When Torquil handed him 30 Euros, Lottisse grubbed in his pocket for some change, and he wondered if the doctor would wash his hands before the next patient.

The police car scrunched up on the gravel outside Lottisse’s house. The two occupants gestured wildly in the direction of the hills. Torquil paused long enough to see Lottisse grab his bag and hop in the back of the police wagon, which sped away with screaming revs, its tyres screeching as it careered left at the foot of street, heading out into open country.
“Hey, doc, you’ll cover for us a bit, eh?”
“What do you mean?”
“Well, we were told about this, er, accident, a few hours back, but didn’t think it was anything, and had lunch before we took a look-see.”
“Oh, I don’t know, I’ll have to file the usual honest report, so now that you’ve told me this, it would be dishonest …” Lottisse burst out laughing at the men’s worried looks. “Calmez-vous, calmez-vous, messieurs, I’m sure it won’t matter that I’m a few hours after the event. Probably happened yesterday, anyway.”

Torquil wandered down the street mulling over the doctor’s sound system piping music to the waiting room and wondering if anyone was there listening to The Stones. He arrived in a few minutes at the one pharmacy in Roseanne – villages with enough people are able to have a pharmacy. The woman pharmacist was warm, business-like and blonde. Torquil felt better, but watched wide-eyed as she heaped up the medicaments – box after box and packet upon packet were plonked on the counter until it looked like a mini replica of the shop contents. There was an antibiotic called Amoxicilline; there was Coaprovel for the heightened blood pressure; there was the unspeakably named Prednizolone, steroids for the urti (commonly known as a sore throat which usually clears in a few days by itself); there was a linctus for the cough, a big bottle of syrup; and mercifully finally, there were sterile meches to be stuck up the nose in case of bleeding. They were imbued with a slow-release adrenalin component, and looked like something you clean the sink with.

In Australian dollars the cost of the prescription was about 110 dollars, five times the cost of treatment Down Under. It was as if Lottisse had seen him coming, had decided that this foreigner could be fleeced, possibly having some business relationship with the elegant pharmacist, indeed perhaps some other relationship, too. Torquil handed over 65 Euros, a ridiculously high amount compared to the cost of the simple meeting with the good doctor. He reflected wryly on the irony of too little for the important consultation and too much for the lesser service by the pharmacist. He also wondered about Dr Lottisse’s mental state when he had strangely said to him to be careful because all therapeutic medication has side effects.

Back at his holiday base he looked carefully at the medication. He had received five items, the outcome of the fifteen-minute consultation which meant less than five minutes of Lottisse’s attention to him, the rest of the time on consulting the drugs manual. Torquil took a little of most of the prescription but gave his friend the cough juice and adjusted the steroids dose lower. In spite of this safety measure, he still got a bit hypermanic because he found himself occasionally beating out a drum tattoo on tables at open-air cafes. Fortunately, this anti-social behaviour did not last long, but he would have preferred if Lottisse had prescribed more moderately. The urti disappeared within 36 hours, causing Torquil to wonder if the French had ever heard of the power of the placebo effect. Maybe they had and just wanted to make sure it was supported.

There was no placebo effect or very much else to be done out at the black skeletal car. It didn’t take Lottisse and the police long to identify the car and its occupants. Jacques Lepoutre was well known in the village. The car was just recognisable as his Renault. He had a wife and family of two. It was clear enough there were four bodies in the car, and the local worthies who investigated after their lunch wrote in their report that it was the Lepoutre family. However, there would still have to be a positive ID done by authorities from the city. Apart from which the deaths and the suicide had happened on Jacques’s land under his favourite fig tree.

Torquil reflected on the over-prescribing of the steroids, the same dose for each of three days. In Oz this would have been a reduced dose each day, a safer and more economical way. After his holiday, safely back home Down Under, he told people it was one of the oddest consultations he had ever experienced and tried to rationalise the encounter by referring kindly to it as customary practice in the South of France, but such profligate prescribing was new to him.

He now wished he had told Lottisse he was a medical person and said what he needed rather than be subjected to a heap of extraneous stuff, such as the fleeting examination, the unprofessional comments and the reaction to phlegm. He could have told him exactly what was wrong without the “examination”, and he could have asked for the appropriate kind and amount of drugs he knew he needed, just a few “botix”, Ozzie for antibiotics. He regretted coming from a professional culture that had not allowed him openly to profess his medical kinship. He wished he had identified his problem, knew what he needed, knew his blood pressure, knew everything … except for the strange consultation procedure. He would laugh later about the money being handed over, but smile wryly when a doctor mate back home told him he had once received a free consultation for owning up to his Italian doctor that he was in a similar business. He also said the Italian’s attitude changed totally and he started speaking fluent English. Somehow though, Torquil couldn’t imagine that ever happening with Lottisse.

Doctor Louis Lottisse attended the funeral of the Lepoutre family. There were 800 others, half the population of Roseanne. No-one seemed to mind that the person who killed his own family was being accorded the same solemn and respectful service as the victims. The procession of candles and lanterns and the graveside ceremony elevated the wretched circumstances. There was something pagan in the way everyone was there, joining in on rituals of farewell for a murderer and the murdered. Devout Roman Catholics were united with the non-religious simply to say goodbye to people they had known. One of the policemen who first investigated was a pall- bearer.

Behind closed doors everyone talked about how Jacques Lepoutre had acquired large quantities of sleep-inducing drugs on prescription by visiting several doctors in the area, courtesy of the French system. He had garnered enough to put a platoon to sleep. Lottisse had been the third doctor he visited on his squirrelling spree. There are those who say that Lottisse should have known, that he should have been able to detect foul play – he knew Jacques as depressive and the possibility of someone able to get drugs from several sources because there was no cross-checking in the system. And yet, he was in the system, a slave one might say to over-prescribing. How was he to know the terrible use that Jacques would put the drugs to? He was blameless, or more subtly, there was no point in blaming him.

It would take about five years for the system to be changed, for the law to decree that you had to have an official doctor, one only, so when you went to a new doctor you would be asked who your regular doctor was. Ironically, this was brought in to deal with the heroin problem.

When the various past patients heard about the deaths and the involvement of Louis, they had different reactions: Gavin’s reverence and admiration for Louis was undimmed; the English woman who wasn’t pregnant and had stopped subjecting herself to Lotisse’s humour, said anyone as flamboyantly silly as Lottisse was bound to err at some stage. Torquil simply said, “Could have told you something like that would happen”, and added it had not changed his bleak view of Doc Lottisse. He did say though that if he visited some doctor overseas again he would not only divulge and show proof of his medical qualifications but would also ask him if he liked The Rolling Stones. Doctor Lottisse vowed to try to reduce prescribing so many anti- depressants and to improve the conditions in his waiting room.