Growing Into Medicine (23 page)

He had developed chest pain and began to fail before we left Wakefield. Biz came from America to visit him. I hate to imagine her misery when she had to return over that large expanse of water, knowing she would never see him again. My brother Arthur and I went home as often as we could. On one of my visits, Father complained that even the weight of his pyjama jacket on his sternum was painful. As soon as I got back to my own home I made a wire cage, sewing strips of foam round the struts in the hope that it could rest on the sides of his chest, holding the material away from the skin.

As I bent the wire and covered it with padding – and tears – I remembered the splint he had made to support the ankle of the boy with osteomyelitis. He always took infinite care with small, practical
details. In the days before disposable syringes and needles, he sterilised them in a glass dish of methylated spirits. Each needle had to serve for many injections. The point could become blunt, or even hooked. I can see him now, holding one up to the light, then rubbing it on a fine whetstone until the point was sharp enough to slip painlessly under the skin again.

My frame was not a success. It tended to slip and cause more pain. But my father persevered with it for a while and I like to think that he appreciated my efforts. He always wanted me to be as practical as any boy.

A consultant physician from Bath visited on a number of occasions. When my father eventually asked if he had carcinoma of the lung he was told, ‘I can’t think of a better diagnosis,’ an apt reply from one doctor to another. Five days later my father was found dead in his chair, his glasses on his nose and the paper on his lap. I have wondered whether, during his time in India, he had, perhaps unconsciously, found an eastern way to let go. If only we could all arrange to depart so neatly.

My mother had nursed him with great care. On hearing the news of his death, Arthur arrived first. Later in the day, I pulled into the drive, full of foreboding about my mother’s state of mind. We both knew she would have nothing to do with the funeral. She dealt well with sickness – but death sent her into a frenzy. I had heard stories of how my Aunt Pip had asked her to fetch something from the room where my paternal grandfather lay in state. As my mother hesitated, Pip, who was not a doctor or a nurse, said, ‘Sorry, I’ll go. For a moment I forgot that you could not cope with dead bodies.’ When D, my mother’s own beloved father died, the whole family were on tenterhooks in case she exploded in a fit of anger about the ceremony or something the vicar said. She managed to control herself but her white face and tight lips revealed to everyone her revulsion and horror. I think her anguish about death was tied up with her fear that she might find herself wanting to believe in some sort of afterlife. For her, that would have been a betrayal of her absolute belief in the non-existence of God or of any spirit separate
from the physical body. Her passion meant that she had to face her losses with no help from any faith or ritual.

As soon as I arrived at Green Gables she disappeared into the kitchen to make me some tea, giving Arthur and me a quiet moment together. He had not brought his wife with him and it had not occurred to me to ask Ralph to take time away from work. We both sensed that this was a moment when it would be easier to deal with our mother on our own.

‘Do you want to see his body?’ Arthur asked. ‘They are leaving the coffin open until I let them know your wishes.’

I said no, almost without considering my options. Since then I have had moments of regret. Did he look peaceful? I wish I knew. At the time all my energies were focused on my mother and how we were going to get her through the next few days. A funeral must be arranged and we were both aware that she would not attend any sort of ceremony. I am sure some of his old patients would have liked to pay their respects and must have thought it strange that no details were announced in the local newspaper.

When my father was obviously approaching the end my mother had sent for his cousin Sylvia Guthrie, of whom they were very fond. In the end she stayed at home with my mother while the two of us went alone to the crematorium. I did not envy her the role she had so kindly offered to fill. We chose the simplest service in the book with a few prayers and no music. Under stress, my bladder becomes irritable. Driving into Bath, Arthur was patient with my need to stop at every ladies’ loo we passed. He is not a great one with words but on that occasion, as on others, he was a substantial rock by my side.

A delayed reaction to my father’s death might have driven me back to general practice, but it was not until Ralph was posted to head office in London that I made the move. The accommodation provided was in Coulsdon, Surrey and I was again faced with looking for work in a strange place where I knew no one. The house was smaller than the previous one so our furniture did not fit. By this
time Ralph was within ten years of retirement and in anticipation we bought our house in Bath and furnished it with surplus belongings. The move was complicated, with two furniture vans, two cars, two cats and the dog. After packing for days I went to Bath with the dog to receive some furniture there, while Ralph took the cats to Coulsdon. I remember sleeping on the floor in the empty house clutching the dog as cramp seized the inner muscles of my thighs in the worst attack I have ever had. The long-suffering dog stood quietly as I clung to her black coat and screamed. For the first time I understood how people who get cramp in the water could drown.

It took me a few weeks to sort out both houses before I looked for work and found a job as assistant in a four-man practice in Caterham, five miles away. Having been out of mainstream medicine for so long I was extremely nervous, but the partners were supportive and tolerant of my many questions. In an effort to boost my self-confidence I studied for membership of the College of General Practitioners and passed the exam in 1979 at the age of fifty. Since then I have not exposed myself to any other exam, although I have considered a musical one to see what grade I have reached on the flute – but have not yet found the courage.

Even with the letters after my name I did not feel properly qualified and still felt something of a fraud. For instance, I had never been in a position where I had been forced to section a mental patient; that is, to sign the papers for him or her to be committed, by force if necessary, to a mental hospital.

For many years my dreams contained scenes where I had chosen to go back to Bristol as an undergraduate and should be spending more time on the wards. In the dark of those nights I am about to start back at university but have not found anywhere to live. Now when I wake in my own room, the pipes ticking as the central heating comes on, the tracery of branches on the Castanea tree beyond the window becoming sharper as the sky lightens, I try to imagine what it must be like to be a displaced person, a refugee without the solid foundation of one’s own place and family. The reality of my good fortune flows through me.

When I felt more confident running surgeries, and had learned my way around the district by doing home visits, I started a special family planning session in the practice. It was a salutary experience. Despite the fact that I was a woman, enthusiastic and experienced, a considerable number of patients continued to attend the local authority clinic in the building opposite. My belief that general practitioners cannot fulfil all the needs of their patients was confirmed, especially if those in search of help are not comfortable with their sexuality.

The doctors in the practice knew of my interest in psychosexual medicine and responded in characteristic ways. The senior man was keen to delegate and sent me straightforward couples wanting to be sterilised whom he could have dealt with himself. The next in the practice was a sensitive doctor who soon realised that I was becoming overwhelmed. I was grateful when he stopped using my services. The third was a jolly ‘man’s man’ who considered anything starting with ‘psych’ was nonsense. He slapped his patients on the back and said their impotence was temporary, due to drink or overwork, and that they would get better. Many of them did. Only the newest arrival, young and trained in family planning, was sensitive to the sort of problems and people who presented in that setting. He sent me patients I could sometimes help.

But the experience I had gained, my comparative professional ease with sexual matters, helped me in unexpected ways. I was caring for an old man who was dying at home, nursed by his devoted wife. I called each day as he slipped into long periods of semi-conscious ramblings. One morning his wife was distraught. I followed her into the front room where we sat for a few minutes. Through her tears she said, ‘I must tell you doctor, last night for the first time, he wouldn’t let me. . . you know. . . help him with my hand.’ For her that sexual withdrawal was the moment she truly lost him. When he died three days later she was all brisk efficiency, washing sheets and paying bills.

It may seem strange to some readers that several doctors working in psychosexual medicine have moved into terminal care. The
sensitivity honed by listening to sexual unhappiness can illuminate end of life decisions. I was greatly moved by Judy Gilley’s work on intimacy and terminal care. To paraphrase two of her cases, she described one man who pleaded for his dying wife to be allowed to stay at home. ‘I want to hold her in my arms for one last night,’ he said. Their home was snug having a ‘faded glamour, with much gilt and pink lampshades’. The other patient was a man who lived in a tidy and sterile house. He started to suffer panic attacks after being diagnosed with cancer. The wife said that he wanted her to do ‘dreadful things’. Imagining these to be intimately sexual the doctor was surprised when she learned he wanted his wife to comb his hair.

It is difficult for me to understand how a woman can feel so distant from her man, although I can relate it to my feelings about my elderly mother. After washing her hair I would comb the tangles with exaggerated care, and it is only as I write that I am reminded of how impatient she was with my own hair when I was small. Another job was to squeeze a cyst behind her ear. It filled up gradually over two or three months with a blackhead at the centre that she hated. My father had done this for her over the years. When I took his place I had to marshal every particle of control to stop myself from gagging. Yet I had done much more distasteful things for patients without any feeling of disgust.

Another memory of my time at Caterham is of a nurse attached to the practice who was trained in terminal care. As well as organising the loan of equipment, commodes and hoists, she attended to small details with dogged patience, suggesting tinned baby food for a woman who could not cope with lumps, a small adjustment to a bedside table, a different arrangement of pillows. In addition she discussed treatment regimes with the doctors, and by listening to our anxieties helped us to bear our feelings of inadequacy, comforting our sadness at being so ineffectual in the face of death.

After about two years I discovered my mother had suffered a transient ischaemic attack (TIA) while visiting Biz in America. She had told no one, but put her name and my address on a label round her neck in case she became unconscious during the journey home.
The effects had been slight weakness in one hand and minimal slurred speech. Over the next few weeks I noticed occasional facial weakness on one side especially when she was tired. As I was finding night work very wearing I used her potential illness as an excuse to leave Caterham and take a part-time job in Purley where I was not required to do any nights and only a few home visits.

Here I met many Jewish families, reminding me of my time in Hendon all those years before, where if one visited on a Saturday one had to creep in at the back. In very orthodox households one must use no energy on the holy day. The ring of the front door bell would desecrate this taboo. A strong sense of family tended to produce anxious parents and we were often called to children who were not very sick. However, the patient I remember most clearly in Purley was not Jewish. She came every day to the surgery, often twice or three times, always with a new symptom and always in a state of anxiety, insisting she must be seen. I found her a great trial. Patients who cry ‘wolf’ can develop a real emergency that goes undetected, so I felt the need to examine her every time.

While I was struggling with her and hoping that Ralph might soon be moved again so that I could escape, I read an article in the
New England Journal of Medicine
. The best thing about it was the title, ‘Taking care of the hateful patient’. The admission that doctors, who were supposed to be ever loving, could hate an occasional patient was a great relief. The authors suggested that obsessional attendees like my patient could be helped by being given a definite time for their next appointment, increasing the gap between visits very gradually. I followed the advice with scrupulous care, starting with appointments the same afternoon, then the next day, two days for several weeks and then three days. All went well until I lengthened the gap to four days. She was back that afternoon, her confidence shattered, never to be regained during my time in the practice.

My boss was a charming man from Sri Lanka who would go out on a limb for his patients. One day he asked if I was busy on the following Saturday, as he wanted some help. He had arranged the adoption of a baby within his practice. Doubts about the legality of
such a thing made me hesitate but he had checked that the new regulations forbidding such personal intervention had not yet come into force. With great trepidation I went with him to the maternity ward where we found the young mother weeping over the baby and taking photos. After a while her own mother led her away and we were put into a side ward with the baby in a crib.

There we stood, a short, dark Sri Lankan and a tall blonde English woman, somewhat incongruous in those days. He rubbed his hands in pleasure. ‘Now we are the parents.’ For the few moments before the new parents arrived we were legally responsible. The baby lay quiet as we gazed down. After a few moments the door opened and a couple came in. They advanced slowly to the crib, not daring to touch their new child.