Permission

Short Story

Dr Harris arrived at the surgery early, as he always did, and sat in his car for a few minutes before going in.

It was still dark. The car park lights hummed. Across the road, the bakery was already open. A van idled, engine coughing, then drove off.

He drank the last of his coffee and checked his watch. Ten past seven. If he went in now, the heating wouldn’t have kicked in yet. The waiting room would still smell faintly of disinfectant and damp coats. He waited.

His lower back ached. It had been aching for months. He shifted in the seat, pressed his thumb into the muscle above his hip. It didn’t help.

When he unlocked the door, the cleaner was just finishing up. She nodded to him, her headphones still on. He nodded back. They did this every morning. She left by the back door. He never knew what she was listening to.

He switched on the lights, booted up his computer, scanned the day’s list.

Twenty-three appointments.

Three sick notes already flagged by reception.

He sighed and opened the first file.

The man was called Alan Cooper. Forty-nine. Warehouse operative. Back pain, ongoing. Dr Harris remembered him. Broad-shouldered, careful in his movements, as if he were constantly about to apologise for taking up space.

Alan sat down and folded his hands in his lap.

‘Morning, doctor.’

‘Morning. How’s the back?’

Alan shrugged. ‘Same.’

‘Still working?’

‘Yeah.’

Dr Harris looked at the screen. ‘You shouldn’t be.’

Alan smiled, quick and thin. ‘Can’t not.’

They sat for a moment. The clock ticked. Somewhere in the building a phone rang and was picked up.

Dr Harris cleared his throat. ‘What are you hoping for today?’

Alan hesitated. ‘Don’t know. Thought you might have a look. Maybe.’

Dr Harris stood, gestured to the couch. Alan got up slowly, one hand on the arm of the chair. When he moved toward the examination table, his gait was stiff, each step deliberate. He hoisted himself up and the paper crinkled beneath him.

Dr Harris went through the motions: press here, bend there, any numbness, any weakness. Alan answered carefully, as if there were right and wrong answers and he was trying to choose correctly.

‘Can you lift your leg?’

Alan tried. His face tightened.

‘How far do you get before it hurts?’

‘Not far.’

‘And at work?’

Alan blinked at the ceiling. ‘I just do it anyway. You know. Got to.’

‘What are you lifting?’

‘Pallets. Boxes. Whatever comes in.’

‘How heavy?’

‘Twenty kilos. Thirty. Sometimes more.’

Dr Harris felt his own back twinge in sympathy. He said nothing.

When it was done, Alan sat back down and rubbed his knee. Then his thigh. His hands kept moving.

Dr Harris returned to his chair. ‘It’s not getting any better because you’re still lifting.’

Alan nodded. ‘I know.’

Another pause.

‘And my daughter needs new shoes,’ Alan said. ‘School ones. They’re thirty quid.’

Dr Harris waited.

‘Van’s got the MOT next week. If it fails, I’m looking at two hundred, maybe three.’

Alan rubbed his knee again.

‘I’m not asking for anything,’ Alan said quickly. ‘Just thought I should come in. Like.’

Dr Harris looked at him. The lines around his eyes, the way his jaw tightened when he spoke. He thought about the warehouse on the edge of town, the one with the high fences and the rotating agency staff. He’d signed notes for half the men who worked there at one point or another.

He opened the sick note template.

‘How long have you got left on your holiday allowance?’ he asked.

Alan blinked. ‘None.’

Dr Harris typed. Not much. Just enough.

‘I’ll put you down for two weeks,’ he said. ‘Rest. No heavy lifting.’

Alan swallowed. ‘Right.’

‘I can’t sign you off indefinitely.’

‘Course not.’

Alan stood. He didn’t smile this time.

‘Thanks,’ he said. ‘I won’t tell them anything. I’ll just say you said.’

Dr Harris nodded. Alan left.

The waiting room was filling up. Through the gap in his door, Dr Harris could see people shifting in their seats. A man coughed into his fist. A woman scrolled through her phone, her thumb moving in tight circles. The heating had kicked in. Someone had left the window open a crack and cold air leaked through.

The receptionist’s voice carried: ‘No, if you can’t access the booking service, then you need to call back tomorrow at eight-thirty. Yes. Eight-thirty.’

A pharmaceutical rep hovered near the desk, sleek in a navy suit, holding a glossy folder. The receptionist waved her away. The rep smiled tightly and sat down in the corner, crossing her legs.

An elderly man near the door was telling someone about his grandson. ‘Doing ever so well. Got himself an apprenticeship.’

The person next to him—Dr Harris couldn’t see who—said nothing.

The next patient was a woman in her thirties with anxiety. Then a teenage girl with a rash. Then a man who wanted antibiotics and didn’t need them.

The man leaned forward when Dr Harris explained it was viral.

‘I’ve been off work three days,’ the man said.

‘I understand.’

‘So do I have your permission to go back, or not?’

Dr Harris paused. ‘You don’t need my permission. You can go back whenever you feel well enough.’

‘But if I’m not better—’

‘It’s viral. Antibiotics won’t help.’

The man stared at him. ‘Right. So nothing, then.’

‘Rest. Fluids.’

The man stood abruptly. ‘Waste of fucking time.’

He left without closing the door. Dr Harris got up and closed it himself.

The morning moved on.

At half past ten, Mrs Ellison came in.

She was sixty-two and worked part-time at the library. She’d been coming to the surgery for years. She sat down and clasped her handbag with both hands. Her fingers worried the clasp, flipping it open and closed. Open and closed.

‘I don’t want to make a fuss,’ she said.

‘What’s been happening?’

She stared at the carpet. ‘I can’t sleep.’

Dr Harris waited.

‘I wake up and can’t breathe. Not properly. I keep thinking I’ve forgotten something.’

‘Anything in particular?’

She shook her head. ‘Just… everything.’

He asked the questions. Appetite, mood, thoughts of self-harm. She answered steadily. Too steadily, he thought. But poor eye contact.

‘And work?’

She smiled faintly. ‘They’re restructuring.’

‘I see.’

‘I won’t have a job, will I.’

He didn’t answer.

‘I thought maybe,’ she said, ‘if I had a note. Just for a bit. To get through Christmas.’

Dr Harris leaned back. He looked at her hands, the skin thin and spotted, the wedding ring loose on her finger. She’d taken something from her handbag—a library card, laminated and worn. She turned it over and over between her fingers.

‘You’re not asking for time off because you’re ill,’ he said.

‘No.’

‘You’re asking because you’re frightened.’

She looked up then. Met his eyes.

‘Yes.’

Another silence.

‘I can write something vague,’ he said finally. ‘Stress-related. Short-term.’

She nodded quickly. ‘That would help.’

He typed. Again, not much.

When she stood to leave, she hesitated.

‘I won’t abuse it,’ she said. ‘I just need a bit of… permission.’

The word landed between them.

She slipped the library card back into her handbag and left.

Dr Harris watched her go.

At lunch, he ate a sandwich at his desk and skimmed the local news. A piece about the council using hotels for emergency housing. Another about the closure of the foundry. He recognised the photograph. He’d signed sick notes for men in that building too.

His back still ached. He stood and stretched. Touched his toes. Felt the pull down his spine, down the posterior chain.

He thought about the ibuprofen in his desk drawer. He thought about taking it. He didn’t.

He sat back down.

In the afternoon, a young man came in with stomach pain that wasn’t there. Then a woman whose blood pressure was fine but who looked like she might cry if he asked her anything else.

At half past three, a man in his fifties came in and sat down heavily.

‘I need a sick note,’ he said.

‘What’s wrong?’

‘Nowt. Just need one.’

Dr Harris waited.

‘I’m owed it,’ the man said. ‘Everyone else gets them. I see people swanning about town on the sick all the time. Afternoons in Wetherspoons.’

‘That’s not how it works.’

The man’s jaw tightened. ‘My taxes pay your salary.’

‘I can’t sign you off if there’s nothing wrong.’

‘There is something wrong. I’m stressed.’

‘What’s causing the stress?’

The man waved a hand. ‘Work. Life. All of this shit.’

‘Are you sleeping?’

‘Fine.’

‘Eating?’

‘Fine.’

‘Any physical symptoms?’

‘I’m tired.’

Dr Harris looked at him. Noted the clean shirt, the expensive watch, the faint smell of cologne.

‘I can’t sign you off,’ Dr Harris said.

The man stood. ‘Useless.’

He left.

Dr Harris sat very still. He felt something inside him he didn’t like. Relief, maybe. Or vindication.

He opened the next file.

At four o’clock, a boy of seventeen sat down and stared at the wall.

‘Your mum made the appointment,’ Dr Harris said gently.

The boy shrugged.

‘She says you’re not going in to college.’

‘Not today.’

‘Why not?’

The boy hesitated. ‘Can’t.’

Dr Harris waited. The boy’s leg bounced.

‘Is someone hurting you?’

The boy shook his head. ‘No.’

‘Are you hurting yourself?’

‘No.’

Another pause.

‘There’s a lad on my course,’ the boy said. ‘He hung himself last month. In the toilets. They reopened them a week later.’

Dr Harris felt something tighten in his chest.

‘And now,’ the boy went on, ‘they keep telling us to talk to someone. But not to miss classes.’

The boy’s leg stopped bouncing.

‘They painted the door,’ he said. ‘The cubicle door. It’s blue now. It was grey before. And it squeaks when you open it.’

He looked at Dr Harris.

‘Now everyone knows which one it is. Where he did it.’

Dr Harris looked at him. Really looked. The acne, the dark circles, the way his shoulders were drawn up as if bracing.

‘I can give you a note,’ he said.

The boy frowned. ‘I don’t need one.’

‘I know.’

They sat there.

‘I don’t want to end up like him,’ the boy said. ‘But I also don’t want to be the one who couldn’t cope.’

Dr Harris printed the note and slid it across the desk.

‘You don’t have to use it,’ he said. ‘It’s just there.’

The boy picked it up. Folded it carefully. Put it in his pocket.

‘Thanks,’ he said. ‘I won’t tell anyone you said.’

After surgery, Dr Harris locked his office and walked out through reception. The staff were already packing up. Someone laughed. Someone sighed.

Outside, the light was fading. He walked to his car and sat for a moment with the engine off.

He thought about the notes he’d written. How many this month. How they stacked up, invisible but cumulative.

He told himself he was helping. That these were small mercies. That if he didn’t do it, someone else would—or wouldn’t.

His back throbbed. He pressed his hand against it.

He started the engine.

As he pulled out of the car park, he saw Alan Cooper across the road, waiting for the bus. Alan caught his eye and nodded. Dr Harris nodded back.

The bus came. Alan got on.

Dr Harris drove home.

His wife was in the kitchen when he came in, chopping vegetables. The radio played quietly. Something about interest rates.

‘How was your day?’ she asked.

‘Fine.’

She looked at him. ‘Busy?’

‘The usual.’

She nodded and went back to the carrots. The knife made small, precise sounds against the board.

He sat at the table and loosened his tie.

‘There’s wine open,’ she said. ‘If you want some.’

‘Maybe later.’

They were quiet. She scraped the carrots into a pan. The radio murmured.

‘You look tired,’ she said.

‘I am.’

‘You should take a day.’

He smiled faintly. ‘Maybe.’

They both knew he wouldn’t.

That evening, he filled in his appraisal paperwork. Questions about safeguarding, thresholds, escalation. He ticked the boxes. Wrote careful sentences.

One question made him pause: Do you feel you are appropriately applying clinical guidelines around fitness-to-work certification?

He read it again. His pen hovered.

He wrote: Yes, within the constraints of individual patient circumstances.

He moved on.

Before bed, he lay awake and thought about the word the woman had used.

Permission.

He thought about how easily it had come to him that day. How natural it had felt.

And he wondered—not for the first time—whether he was easing people out of trouble, or simply smoothing the way for something else to happen later, somewhere he would never see.

His back ached. He turned onto his side. The pain got worse.

Four days later, he saw Mrs Ellison in town. She was shelving books in the library, moving carefully between the carts and the stacks. She looked up and saw him through the window. She didn’t wave. Neither did he.

She went back to her work.

He kept walking.

The following week, Alan Cooper wasn’t at the bus stop. Dr Harris looked for him on Tuesday. Wednesday. Thursday.

On Friday, he checked the appointment list. No Alan Cooper.

He told himself that was good. That Alan was resting. That the note had worked.

He didn’t know if that was true.

In the morning, he would unlock the door again.