Paula Spencer, nee O'Leary, is 37 years old. She looks much older, although she might have been good-looking once. The booze and the fags have taken their toll. She has four children, one of whom is an addict. They have not been well fed, probably because the money goes on vodka, and they've all been bed wetters. She was married to a small time crook who managed to get himself killed by the Garda during a bungled robbery. He was a charmer, though, and handsome, always very concerned about her when she had yet another fall under the influence. He would take her to the hospital and stay with her whilst she was treated.

Paula has a thick medical record. It bulges with reports from casualty about her black eyes and broken bones. She has been to her general practitioner on numerous occasions with complaints of tiredness and depression. She has never heeded the advice to cut down on her drinking and give up smoking, even when pregnant. She's on Valium most of the time.

“The doctor never looked at me. He studied parts of me but he never saw all of me. He never looked at my eyes. Drink, he said to himself. I could see his nose moving, taking in the smell, deciding.”²

Doctors don't like Paula very much. She could be described as a “heartsink” patient which probably amounts to the same thing. She doesn't like them either. They have singularly failed to help her. This is put another way in a paper by …