Growing Into Medicine (15 page)

The next morning we went into the ward to find Helen sitting up in her bed studying an alphabet book. ‘Look Mummy, that is a V and that a W.’ She had never identified them before. Clearly she had not suffered any lasting brain damage. I left the room and wept while Ralph sat with her identifying more letters.

10

The Tug of Domesticity

By the time we moved to Wormwood Scrubs in west London, after three years on the Isle of Wight, I had accepted that our unsettled life would make it impossible for me to get a job as a hospital specialist. I needed to remain in the sort of work that would be easily available, even if we were a long way from the big centres of population. My mother and others thought I was at a great professional disadvantage; for me it was an excuse to forgo the struggle up any academic ladder. But I had become bored by community infant welfare and school clinics. I took on some surgeries in general practice but they did not fit easily into my domestic set-up.

Ralph was still on duty every other weekend, but came home earlier than he had done when working with young offenders. I had to juggle surgeries with his hours and the regular task of driving Helen to and from school. This made me consider the possibility of training to work in family planning clinics, which were often held in the evenings. So far I had avoided the Family Planning Association (FPA), for it had been started and was run by lay women, whom I associated with the sort of do-gooders my mother despised so much. . . who wore large hats and spent their time at tea parties. My friend and colleague Heather Montford reminds me that the family planning doctors were often considered ‘nice ladies in twin sets and pearls’ who had taken up the work as ‘something to do in the evenings’.

Such ignorant views were a parody of the truth. The FPA had been formed by dedicated pioneers who appreciated the plight of
women with no access to birth control. It took time for me to realise what an enviable position I had enjoyed, growing up in a family where such matters were discussed. My father was isolated as the one GP in the area, possibly even in the country at that time, prepared to give advice and fit vaginal diaphragms, the only reasonably reliable method for the woman to use. I am sure this was prompted by his wish for women to have healthy babies, spaced appropriately, but I suspect my mother also encouraged him to provide the means for women to have some control over their own bodies. Before the 1970s doctors did not consider that it was their job to give such advice. Only with the introduction of the pill did they show a reluctant interest and it was many years before they began to offer the full range of services developed by the FPA.

When the NHS was introduced in 1948, family planning was not included. A network of FPA clinics continued to offer a service for which patients paid a modest fee. The pill was approved for use in these clinics in 1961 and the intrauterine device (IUD) made its appearance a few years later. The organisation trained their doctors and nurses well, and then employed them to run the clinics. Under the supervision of the Medical Director the basic training demanded attendance at a training clinic for at least six sessions, observing and then seeing patients under the critical eye of a training doctor. Once I had obtained the necessary certificates I started to do locum sessions and was soon appointed to a couple of permanent clinics within easy reach of the prison.

Following Helen’s episode with the cough medicine I had become an even more anxious mother. This was not helped when she developed vestibular neuronitis, a viral infection of her inner ear that gave her acute vertigo. The symptoms came on one evening when I was at a clinic – where Ralph phoned me. I finished the remaining patients and dashed home convinced, for some reason, that she had a cerebral tumour. We wrapped her in a blanket and carried her to the Hammersmith Hospital, almost next door to our house. The doctor on call tried to reassure me and arranged for us to see the consultant paediatrician the next day. She did not recover as quickly
as the specialist expected. He put the blame on me for being a working mother. He insisted I take at least three months off work to look after her.

It is difficult for anyone who has not suffered from true vertigo to understand what it is like. Only recently I heard of an American soldier who had fought in Vietnam and seen much active service. He said that none of those experiences had instilled the same degree of terror as an attack of vertigo. I once asked Helen if it was like the self-induced dizziness when one had spun round and round as a child, or ridden on a roundabout. She said it was nothing like it; the disorientation was complete, with no idea where you were in space, in relation to the ground or sky. I suspect it induces such dislocation that the sufferer feels, at some level of the psyche, as if she or he is dying.

After a week or two Helen was still unable to walk. The punitive attitude of the consultant was offset by heart-warming compassion provided by Simon Latham, a paediatric registrar. I first met him while we were, for some reason, waiting on the ward. Another doctor was jeering at a young child who cried incessantly. Simon frowned at the doctor, picked the child up and carried her around, soothing her distress while continuing to look at charts and make decisions.

Each morning for several weeks Simon left home early to allow time to call at our house on his way to work. He knelt on the floor to encourage Helen to take her first steps. Helping her gain confidence was a slow process but he had endless patience. Gradually over a period of weeks she was well enough to return to school but was still suffering symptoms that made her so frightened that they sent for me on several occasions. As the staff waited for me to arrive, a male teacher would clasp her tightly in his arms and carry her up and down the playground. It is sad to think that the essential comfort of being held when one is terrified might be forbidden now, for fear that it would be misconstrued as abuse.

When Helen had recovered, we went together to Shepherd’s Bush market and bought a guinea pig for seven and sixpence. We called
her Abbie. Her fur grew in rosettes, typical of her Abyssinian breed. Three days after she arrived she produced five of the most perfectly formed babies. Within an hour they were running around with their eyes open. Ralph named them after Carthaginian generals all beginning with H. It was typical of him to know the historical details of what was to me rather an obscure period of history. The unwieldy labels for such tiny creatures added to their charm.

Moppet, our cat, had come with us from the Isle of Wight but we were concerned about the main road that ran close to our house. Beyond it the railway embankment must have contained plenty of mice. Fearing the cat would venture across, and in the hope of curbing her hunting instincts, we decided to control her fertility. We opted for a contraceptive hormone injection, as none of us wanted to have her sterilised. The method had recently become available for animals but unfortunately the dose was still experimental. She conceived again before either her system or we were ready for another family. Healthy kittens keep their eyes shut for about ten days after they are born. When this litter was born they had their eyes open – with disastrous results. Because their eyelids had not formed properly the fur rubbed on their eyeballs, causing intense inflammation of the cornea.

We were due to travel abroad on holiday so we left Moppet and the kittens with an expensive but brilliant vet. He managed to save just one of them by performing several operations to create new lids with skin grafts. She grew into a charming cat. The pads of her paws were black and Ralph called her Siksika, one of the names the Native American Blackfeet call themselves. She was timid and never managed to catch anything bigger than a spider, but her pride when she brought us such a treasure was as great as that of the most proficient rat catcher.

My memories of work at that time seem blurred, while domestic details stand out more sharply. The blame that I had received for Helen’s vertigo concentrated my energies on trying to provide her with the stability and interests that I imagined a good mother would manage with automatic ease. However, from the beginning I found
work in family planning clinics very absorbing. I was meeting a group of patients who were in the main fit and healthy but were in urgent need of medical help to control their fertility. I soon discovered that in this personal area of their lives the ideas and feelings of the patient and her partner were more important than the views of any professional. This is not to deny that the doctor had an important traditional role to play, especially with the comparatively new methods. We were trained to take detailed histories, always check the blood pressure and perform a pelvic examination before prescribing the pill. (Later there were many debates about the necessity for this procedure as it could deter women from taking the precautions so necessary to delay or space their children.) If there were some absolute contraindication to a method the doctor had a duty to refuse it, but where there was a relative risk this had to be weighed against the risks of pregnancy and discussed with the patient.

I quickly became fascinated by the challenge of remaining an authoritative doctor when it was necessary, while developing listening skills to try and understand the person in front of me. I had no idea that this body/mind approach was to become the central interest of my professional life.

For the moment I was immersed in my family. I still yearned for another baby but as well as accepting that I would never be a great hospital specialist I was beginning to realise that I might have to be content with only one child. A large room at the top of the three-storey house, one of those outside the walls of the prison that had been provided for us, made a good playroom. I filled it with a slide, Wendy house and various push and pull toys for any of Helen’s friends I could entice inside. I encouraged our friends, who were fond enough of Ralph to tolerate his silences, to visit as often as possible. I clung to these visits, and to our holidays, as times when he became more approachable and more interested in us.

Soon after arriving on the Isle of Wight we had gone to Sennen Cove in Cornwall with Dilla and Alan Roberton. For me it was one of the most enjoyable holidays we ever had as a family. Their
daughter Jeanie was about nine and showed great tolerance as she played with the three-year-old Helen. Ralph came out of his shell and did more excursions with them than he would have done with us alone. We went to Kynance Cove. As the tide receded he was the first to explore a headland. He came running back.

‘Alan, Alan,’ he called, ‘come quickly.’

For a moment I thought he had found a dead body. I stood still and looked at Dilla as Alan sprinted after him out of sight.

‘Isn’t it wonderful? The most perfect bay I have ever seen, quite untouched by the foot of any human, animal or bird.’

Instinctively he had wanted to share his excitement with his male friend, but I was so glad to hear the happiness in his voice that I felt no jealousy.

Interspersed with our visits to Cornwall we went to France, often to Biarritz. In the sixties it had a faded Edwardian elegance and was not in the least fashionable. We first discovered the place when Helen was about four, after driving through France with no fixed idea of our destination. Later, when Jeanie was a teenager, we took the Robertons with us. On the way down we stopped at a lake in ‘Les Landes’, the wide expanse of pine forests in southwest France. Jeanie and I had sailing lessons conducted in Old French. Some of the commands still vibrate in my head (I don’t know how to spell the words) along with
beignets abricot
, the call of the doughnut sellers on the Biarritz beach.

Once Helen had learnt to swim, on holiday in Madeira where there was a wonderful sea water pool, we could return to the inland waterways, spending a week travelling down the Thames in a camping punt. At the school in Holland Park she had made great friends with Lucy Crowther, the youngest daughter of an editor at the
British Medical Journal
. Lucy came with us on the river. That trip took place soon after Helen’s vestibular neuronitis and the peace was healing for both of us. The two girls sat in the bow of the boat catching leaves and twigs and ‘sending them home’ to the bank while Ralph punted and I just lay on the cushions in the middle.

Almost despite myself, between these holidays I was becoming
more interested in family planning work. It must be difficult for anyone in the twenty-first century, with sexual matters constantly in the media, to imagine the degree of prejudice that had to be overcome both among the general public and the medical profession. But at about this time a number of pioneering doctors, mainly women, were starting domiciliary services in big cities, including Dr Libby Wilson in Sheffield and then Glasgow. Anyone interested in this vital work should read her memoir,
Sex on the Rates
.

I was not one of those medical pioneers who took up the fight, although I admired them enormously. In any venture there are those spirits who forge the new trail, revelling in the fight against prejudice and entrenched ideas. Others follow who consolidate their vision. Both in timing and temperament I was one of the latter.

During this time, a group of family planning doctors were meeting with Dr Tom Main to discuss the psychological influences on contraceptive choice, and the sexual difficulties that often presented during the consultations. Looking back I cannot understand why I was not among them. Tom, who had been analysed by Michael Balint and became a close colleague, had been present when I was interviewed for the GP group eight or nine years previously when we were living in London. At that time they had considered the ‘small but essential change in the doctor’, necessary for the development of a more psychological approach, took at least two or three years. They had been worried that the single year I was to be in London would only unsettle me. ‘Is half a loaf for a starving woman more useful than none at all?’ they had asked each other, in my hearing. In the end I had been accepted on the understanding that I might be available to join another seminar at some later date. Yet here I was back in London, making no move in that direction. Perhaps I was too consumed by the need to be a perfect mother and wife, and to maintain what social contacts we had, to be able to face the emotional demands of such training.