Chapter 6 The Doctor's Advice

Some Facts of Life

"I don't usually see you in the village at this hour of the day," Dr. Clarkson said, coming abreast of Mr. Carson in the High Street one afternoon during what was the regular hour for tea at the Abbey.

"Dr. Clarkson." Carson greeted the man affably. "No, you don't. The family is away until late," he added. He did not have to explain himself to the doctor or anyone else, but he recognized the question as a harmless social greeting and responded to it in kind.

"Indeed. Then perhaps," the doctor hesitated, and then went on, "perhaps you would join me for a drink. I've not had the opportunity to congratulate you - properly - on your engagement."

They were not friends, the butler and the doctor. Their social inequity inhibited that. Dr. Clarkson was something of an anomaly in Downton Village. Like everyone else, he was dependent on His Lordship for his living. Downton Cottage Hospital was largely funded by the endowment established by His Lordship's father, the Sixth Earl of Grantham. Dr. Clarkson himself served as the chief medical practitioner there at the pleasure of the hospital's board, which was dominated by Her Ladyship the Dowager, although ultimate authority resided with His Lordship himself.

And yet the doctor also stood apart from the villagers, tenant farmers, and those directly employed on the estate because he was a professional. The superior status he derived from this - only Mr. Travis, who held the living on the estate, was at all comparable - made him a socially acceptable visitor at the Abbey and at the Dower House, something beyond the reach of other commoners. As such, the doctor ranked above the butler, a fact subtly indicated in the way they spoke to each other. Carson addressed the doctor by his title and surname, whereas Dr. Clarkson observed the family's practice, referring to the butler only by his surname.

But they had, of course, known each other for decades. Dr. Clarkson was the only doctor in the community and was a well-known face at the Abbey, tending to the ails of its inhabitants upstairs and down. He had treated Carson over the years only a few times, the butler generally enjoying good health. But they saw each other more frequently across the social divide of formal events at Downton, the doctor securing occasional invitations to such functions. And he had had a rather more pronounced presence during the war when Downton had served as a convalescent home under Dr. Clarkson's authority in a military capacity. In such circumstances, their social division was pronounced, the doctor consorting with the family, the butler, as always, in service.

Mr. Carson held the doctor in some regard, not only for his medical expertise, but also because the man behaved impeccably whenever he came to the Abbey in a social situation, and always treated him with respect.

This divide was not inflexible, however. Although Carson could not have accepted an invitation to tea from Her Ladyship the Dowager, as Dr. Clarkson could, it was not unreasonable to take up the latter's offer of a drink, especially in such an informal context. So Carson assented and followed the man through the gates of the Downton Cottage Hospital and into the doctor's private office.

It was a congenial setting. There were glass-fronted cabinets of medicine and filing cabinets of medical records, as befitted the professional purposes of the room, but there were also comfortable chairs and Dr. Clarkson produced a bottle of fine whisky and heavy, but attractive, crystal tumblers from which to drink it.

"How are the wedding plans going?" the doctor asked, pouring two shots of whisky and sliding one glass across the desk to Carson.

It was the standard question and Carson heard it almost every day, or so it seemed. He picked up his glass. "I hardly know," he said, which was both the easiest and most accurate answer. "It doesn't seem to be something that is supposed to concern the man."

Dr. Clarkson smiled wistfully. "So I've heard."

They each took a sip of their drinks and silence prevailed for a moment.

"I'm a little envious of you," the doctor remarked. "Getting married, and to woman you know and love so well. You've been blessed."

"Well." Carson did not know how to respond to that. He was never at ease discussing with anyone, even Mrs. Hughes, how much he loved her.

"Better late than never," Dr. Clarkson said, almost to himself. And then, seeing the other's perturbed expression at this, swiftly added, "I mean it. I'd like to be so fortunate."

It was an odd thing to say. Carson had never given the doctor much thought beyond calling him at the appropriate moments of an illness at the Abbey. But they'd known each other, at least in passing, for decades. Dr. Clarkson was a Scot, but he'd served the cottage hospital at Downton all his professional life. And never been married. It was odd that Carson should find himself realizing this only now. But then, he'd never thought the life of a bachelor anything to remark upon, seeing it as perfectly normal. Now that he was on the cusp of change in that relation, he was more sensitive to it.

"Mrs. Hughes is an admirable woman," Dr. Clarkson said, unprompted. "And you've always seemed to get on so well."

"We do," Carson murmured, forgiving the doctor his earlier presumption. His mind was suddenly occupied elsewhere. "May I ask you a question, Dr.? I know I'm not speaking to you professionally...," he held up the whisky that denoted the social nature of this exchange, "...but...here we are."

Dr. Clarkson nodded amiably. "Of course. And I can assure you of my confidentiality, no matter what the reason we find ourselves in conversation."

That jarred Carson just a little. The doctor seemed to be anticipating the nature of the query. But as that was exactly where he was going, and something he would have been uneasy about in terms of discretion anyway, it seemed a bit ridiculous to get tied up over it. "Is there any reason I should ... take things...easy... in marriage?" He didn't know quite how to put it.

Fortunately, Dr. Clarkson was accustomed to the euphemisms of a tightly-wound and reticent English community. "You're in good health in general terms?" he asked.

Carson nodded. "As you would know, I've had no health concerns for years, not since that bout with the flu. And no recurrence of that strain during the war."

The doctor shrugged. "Then you should be fine. No need to ... take it easy. The important thing is to listen to your body. It usually tells you your limits."

Carson was thoroughly familiar with the communications of his body, especially recently, hence his question.

"One thing you might bear in mind is that ... certain functions don't always operate as well when you get older. It takes longer ... or sometimes it doesn't quite get there. That's perfectly normal, too. The important thing is not to get too tense about it."

To this advice, Carson shook his head. "That's not going to be a problem." Although that was the question that had popped into his head, no sooner had the doctor responded, than another concern occurred to him. "I'm sorry to press you, Dr..."

"By all means." Dr. Clarkson's raison d'etre was helping people. He was always glad to do so.

"What about ... Well, are there any special considerations with regard to ... a woman of a ...certain age?" He was thinking about Mrs. Hughes's apprehensions about this aspect of marriage. Perhaps she had reason to be apprehensive. He doubted whether she'd been in to inquire of the doctor.

"There are," Dr. Clarkson replied warmly. "Like men, things aren't always functioning at their best as women age. It's beneficial for the woman, and just easier for the man, if there is some ... well, for want of a better word, lubrication present. This occurs when a woman is stimulated. Sometimes it takes longer with an older woman. She might require additional... care... to ... be at ease. And, remember, it will probably be uncomfortable for her, likely even painful the first time, no matter what. Perhaps for some time, even. You can't completely offset that, but you can make it easier. So it's important to be as attentive as you possibly can."

There was some vague awareness of this in the back of Carson's mind, something he'd heard once or twice, possibly ages ago. It was odd how this had become a complicated matter in itself. To hear men in those long ago days in the theatre going on about it, it took no thought at all.

Dr. Clarkson noted the almost dismayed look on Carson's face and had some sympathy, divining what he might be thinking. "Perhaps I've said too much," the doctor said.

"No." Carson turned to look Dr. Clarkson straight in the eye. "I've no pride to be wounded in this exchange, Dr. The fact of the matter is that Mrs. Hughes is not the only novice involved. I'd be grateful for any advice you have to offer." It was striking how context altered everything. To discuss such intimate matters with Mrs. Patmore had been an agony, because to do so was highly inappropriate. It was much easier to speak frankly to the doctor. The clinical surroundings, however comfortable, helped. But so, too, did the doctor's semi-formal manner. And this was something that fell naturally within the doctor's bailiwick.

"Well,...there is something else," the doctor added then, encouraged. This drew the other man's attention. "It's ... I only raise the matter because I sense that you are interested in your wife's ... positive experience with this." It was difficult to talk about such things, but they neither of them wanted to be direct without the other's overt approval. Dr. Clarkson reverted to a generic reference in order to distance himself slightly from the personal relations between Mr. Carson and Mrs. Hughes.

"Go on," Carson said cautiously.

"May I be explicit?" the doctor asked. "I don't want to make you uncomfortable."

Carson did not flinch. "I am embarking on this journey quite late in life, Dr. Clarkson," he said gravely. "I don't have a lot of time to waste on learning the basics. A few hints would help."

"Your frankness does you credit, Mr. Carson," Dr. Clarkson responded, genuinely moved by the man's openness and his interest in his wife-to-be's comfort. He took a deep breath. "It's not so widely recognized by men - at least not in my experience of ministering to women - that women are capable of the same ... extent ...of physical arousal as men, though the mechanics are different."

This was news to Carson who was taken aback. But he took a deep breath and nodded for the doctor to continue. This was, after all, precisely the specialized knowledge he sought. And, while the idea of a woman - the woman in his life, Mrs. Hughes, ... Elsie - so enraptured was rather startling, if it might bring her pleasure, was it not worthwhile knowing about it? "Go on," he said again.

"They achieve this through much the same kind of physical stimulation as men do." Dr. Clarkson, who did not often find patients so attentive to his instructions, explained in detail. When Carson looked puzzled, the doctor pulled out a pen and paper and drew a diagram. "I hope I haven't offended you," the doctor said finally, crumpling up the paper and tossing it in the waste basket.

"N - n - no," Carson said slowly. Offended was not the word for it. Astonished, perhaps. "You have opened my eyes, though. And I am grateful for it. I would never have got there on my own." He wasn't sure he could go there, but it was good to know. He was quite certain Mrs. Hughes would not know about this. Really. How could she?

"Most men don't," the doctor said brusquely. "And then they wonder why their wives are not that interested in ... well. A little knowledge can make all the difference." He leaned back in his chair and swallowed a mouthful of whisky, hugging the glass to his chest, an expression of sadness drifting over his face.

"Dr.?" Mr. Carson wasn't usually that perceptive about other men's feelings, but the man seemed to have lapsed into melancholy. It was a strange response to the subject matter.

Dr. Clarkson sighed and then turned to meet Carson's inquiring gaze. The doctor's eyes, Carson noted, were as blue as Mrs. Hughes's, but there was a dullness to his, whereas hers sparkled. "You've been straightforward, Carson, in a way few men are. You're interested in making sure that ... things are done right ... so that this part of your life may be enjoyable for both you and your wife. I'm glad to give you what advice I can. But I will confess that my knowledge is theoretical. It will serve you well, at least I hope it will, but..." Their eyes met over their glasses. "Yet another reason for me to envy you."*

"You've been married to your work," Carson said sympathetically, "as I have been. We neither of us have had much time for it. Until lately, at any rate."

"But the woman you love loves you, Carson," the doctor said darkly. "I have not had the same good fortune."

"I am sorry to hear it," Carson said warmly. He could not imagine of whom the doctor might be speaking, but the man's sadness was genuine, and Mr. Carson felt for him.

"Another thing, while I think of it, Carson." The doctor spoke abruptly, trying to regain his own equilibrium by resuming his professional demeanour. "About ... women. They're not always as ... well informed...as men usually are... about their own potential in this area. Especially women of ... a certain age. A few women are sometimes knowledgeable, but it's a fact of nature that they just don't spend as much time ... thinking about it ... as men do. I would advise you to approach the whole business... gently."

Good advice indeed.

Loved and Lost

Because of the family's absence that evening, the staff ate at "a more civilized hour" - as Mrs. Hughes put it - and they all had some rare time to themselves. Mr. Carson wold not retire until the family came home, his last duty of the evening to secure the house, and Mrs. Hughes stayed up with him, taking advantage of a more relaxed evening together in her sitting room to finish off a very nice bottle of Chateau Montrose, which the family had abandoned the night before.

"You're quiet tonight," she observed. She'd been filling his ear with wedding details, mostly about the menu which she'd gone over with Mrs. Patmore. He'd not taken his eyes off of her, but she didn't think he was completely with her either.

"Am I?" He stirred guiltily and scrambled for something to say.

"And you've been looking at me...oddly." She frowned a little, not quite certain what to make of his absorption. "Is there something amiss with my dress?" She doubted this. He'd never hesitated to offer such critical comments in the past.

Her observation made him shift even more uneasily. She was right. He had been quiet and he was staring at her, and had clearly not disguised his interest very effectively. How fortunate that she could not discern his thoughts. The conversation with Dr. Clarkson continued to distract him. How could it not? It was not as if his thoughts had never strayed to the subject of marital intimacy. Ever since Christmas Eve, he had spent what he considered an inordinate amount of mental and emotional energy on that very subject. But as consuming as his thoughts had become, the much more explicit information imparted by the doctor hours earlier had broadened this realm immeasurably. He found that he could not take his eyes off of Mrs. Hughes. Nor could he close his mind to what the doctor had said.

Imagine a woman experiencing those kind of feelings as men had about that. He'd had no idea. In a way it seemed rather foolish to think otherwise. They were all human, after all. And yet somehow it had come as a surprise to him and he had to assess his response to it. Did this knowledge detract from his respect for respectable women? for Mrs. Hughes in particular? He had somehow imbibed the view that good women were somehow above sensuality. What did it mean to know that they were not? And it wasn't just a matter of accepting this fact of women's nature, but also of acting upon it. Dr. Clarkson's revelations had been explicit and detailed. Carson wondered, as he stared at Mrs. Hughes from this very different perspective, whether he would ever find the courage to touch her like that.

"Mr. Carson?"

He looked up at her and another unsettling thought struck him. Dr. Clarkson attended all the residents of Downton Abbey, including Mrs. Hughes. In that capacity, admittedly as a professional - and Carson would never doubt the doctor's scrupulous adherence to ethical behaviour - he had probably seen more of Mrs. Hughes than he had. It was odd to think of another man having such an advantage over him.

"I had a conversation with Dr. Clarkson today," he said abruptly.

"Are you all right?" A little line of worry creased her forehead.

"Oh, yes," he said immediately, dismissively. "Nothing like that. It was a social conversation, really. He asked me in for a drink, a sort of pre-wedding, well-wishing...," marital-advice-and-intimate-knowledge-imparting, "...sort of thing." He could hear the false heartiness in his voice and made a serious effort to quell it. "He said something...curious."

Mrs. Hughes merely raised an inquiring eyebrow.

"Well,..." He didn't know quite how to put it. "He was congratulating me on marrying for...love..." As he said this, Mr. Carson felt his colour rise a little. The emotional bond between himself and Mrs. Hughes was undeniably there, and they had made some progress in their expression of it - both in words and physically - but it still did not come easily.

His stumbling over this brought a smile to Mrs. Hughes's face. She was as disinclined as he was to express her feelings overtly, but she enjoyed his awkwardness when he tried.

Mr. Carson hurried on. "And he said I was fortunate that my feelings were reciprocated and he had not been so blessed." There. Now he was on firmer ground. "What do you think he meant by that?"

This was hardly the turn of conversation that Mrs. Hughes had anticipated, but it intrigued her. "Well," she said thoughtfully, "only that he has loved and the woman he loves, or loved, didn't love him back." She spoke without inflection, but did feel a twinge of sadness. She liked Dr. Clarkson very much and the fact that he was a fellow Scot was only a part of it. Mrs. Hughes always respected someone who was good at their job and Dr. Clarkson was, in her view, a skilled medical practitioner. She had personal experience of his professional skill and his compassion. Unlike some, she did not hold either his misdiagnosis of Matthew Crawley's war injury or Miss Lavinia Swire's death from the Spanish flu against him. The first, in her view, displayed an appropriate caution in an unusual case - and it turned out well in the end, anyway - and the second could hardly be laid at his doorstep. The Spanish flu respected no medical degrees. And he had been in the right in Lady Sybil's traumatic childbirth, and been prevented by that arrogant London "expert" from acting in a manner that would have saved her life.** Yes, he was a good man who deserved as much happiness as anyone else.

"But...he's lived here for decades," Mr. Carson went on, in a slightly incredulous tone. "Who could it be?" He was pleased with himself for re-directing both his inner thoughts and the conversation into calmer waters. And he was also genuinely curious about the doctor's admission. Even the butler of Downton Abbey enjoyed gossip, when it was exchanged discreetly with Mrs. Hughes. She knew almost everything. He rather hoped she would share more of it with him once they were married.

"Well, it's Mrs. Crawley, of course."

He didn't know whether to be more surprised by the answer itself or the fact that she knew it. "How would you know?" he demanded.

She sighed. "Oh, I've seen it in his eyes," she said quietly. She knew that look, had seen it in the eyes of other men staring at the women they loved, long before she ever saw it directed at herself in Mr. Carson's gaze.

He decided not to challenge her assertion. No doubt she was right, although it would never have occurred to him.

"He's a doctor, and she was a nurse," Mrs. Hughes said helpfully. "And her father, brother, and husband were all doctors, too. They have ... had, I suppose,...a lot in common. When she first came here, she spent a lot of time at the hospital, you'll recall." She knew he would recall it, if only because Mrs. Crawley's interventions there had so irritated Her Ladyship the Dowager, which had, of course, incensed Mr. Carson. "And they worked together closely during the War as well."

"What happened, then, do you think?"

She shrugged. "I don't know. Maybe he's asked and she's declined. Or maybe...he never worked up the courage at all. It takes some men ages." Mrs. Hughes stared pointedly at Mr. Carson.

He ignored her. He'd gotten there in the end, hadn't he? "And...now Lord Merton is in the picture," he said instead.

"Well, it seems more likely, from what he said to you, that they've had it out and she wasn't interested. I doubt he'd have put it quite like that if he was pining for her from afar."

They lapsed into silent contemplation.

Mr. Carson felt for the man. He knew what it was like to love and lose, and though his experience of that had occurred decades ago, he remembered the pain, even the wound itself had healed. More recently he'd known the anxious uncertainty of loving Mrs. Hughes without knowing - for sure - that she loved him back, and had dreaded the prospect of a broken heart a second time around.

"It's a pity," Mrs. Hughes went on, breaking into his reverie. "He's such a charming man, Dr. Clarkson."

"Ought I to be jealous, then?" he asked idly, teasing her now.

Her thoughtful frown smoothed into a warm smile. "Oh, go on with you."

*A/N1. From a 21st century viewpoint it is sometimes difficult to imagine a life lived without sexual experience, but historically this has not always been the case. This did not stem from lack of interest, or necessarily from sterner moral codes - although this had a restricting influence. Social circumstances and lack of opportunity were also factors.

**A/N2. Dr. Clarkson may have admitted that the prospects for saving Lady Sybil were slim, but it is realistic to think that Mrs. Hughes, not privy to the doctor's later investigation of the subject, would continue to hold this view about the event.