Growing Into Medicine (27 page)

Gill went on to lead seminars and to follow me as chairman of the IPM, a job in which I was greatly helped by Heather Montford who was secretary at the time and did most of the hard work, especially the letters and visits to the Charity Commission that were needed in order to get the training organisation accepted by them. Jimmy’s wife Jo Matthews had served on many committees while a member
of PPA and other voluntary bodies, chairing several of them. She lent me a useful book on the art of running a meeting. One piece of advice stays in my mind; members must be allowed to have their say but if there is something you particularly want them to pass, put it late on the agenda for they will be much more likely to let it through when they are tired and hungry.

Writing about these old friends I am assailed by one particularly poignant memory. Gill and Jimmy and I were sitting in the garden on a summer’s day under the cherry tree. We had been working on ideas for her book for some time, when Ralph appeared carrying a tray of iced drinks and nibbles. He seldom took on a domestic role of any kind, often appearing unsociable and not overly hospitable. My surprise was mixed with delight. In some way, perhaps because Jimmy was an old friend from their Oxford days, his reserve had melted so that he could find a reason to join us. While we sipped our drinks I felt a complete person, happy in every section of myself, my professional and personal lives merged for one brief, sunlit moment.

18

Safe Spaces

The last ten years of my life as a doctor, which coincided with the last decade of the twentieth century, were a time of personal consolidation and professional development. My psychoanalysis was both time-consuming and expensive but it gave me the confidence to adapt to widowhood and live more fully.

In addition to deciding what food I liked to eat after Ralph died, I had to discover how I wanted to spend my holidays. The first spring, Helen and Simon took me with them to the Lake District. In the back of their car, where I was not able to hear their conversation, I was freed of responsibility, a child again sitting behind her parents. My elder grandson Alec, raised in his car seat by my side, took the place of my sister Biz, with whom I invariably argued. My mother used to keep barley sugar sweets and peppermints in the front pocket to pass back when our squabbles became shrill.

In the rented house near Windermere I took Alec out in his pushchair while his parents did the chores. A stream ran through the village. One morning two mergansers were diving in the fast-flowing water. They were new birds for me and when I identified them from the book I felt a flutter, the first spark of interest in anything since Ralph had died.

During the twenty-one years since, I have travelled with several different friends. One year, in early September, I was standing with Jo Matthews by our hired car in Alberta. The huge expanse of yellow stubble stretched in every direction. As I absorbed the scale of the place, a skein of geese appeared over the lip of the huge horizon.
Turning, I saw another coming up in the distance behind us, then another and another as if they had been called from every compass point. After converging towards us they circled, before disappearing into a dip in the ground that hid their rendezvous. The noise of sibilant wings gave way to a swelling chatter, each individual seemed driven to share the story of his day.

What makes this image so magical? Is it the symmetry of their lines, their unerring sense of direction, their mastery of an element into which the earthbound human cannot enter? I did not realise at the time that the merganser and the geese were premonitions of one answer to the question of my future holidays, an interest that had been latent since a family holiday during the war.

We had been staying on the east coast of Northern Ireland in a cottage belonging to Professor Hugh Meredith, my mother’s bearded cousin with whom we had been allowed to eat ice creams in Chippenham High Street. He was there with his second wife. Biz and I had to share a bed. As usual, when forced into close contact, we fell out. After one row, my mother shouted at me and I went down to the beach where I watched a flock of small wading birds running back and forth with the waves. I now suspect they were sanderlings but at the time I had no idea of their name, only that their instinctive behaviour was soothing. When I was calm enough to go back to the others, Hugh’s wife took me on one side.

‘I saw what happened with your sister,’ she said. ‘You did not start it.’

I loved her for noticing – and for the tactful way she healed my feelings.

Dogs and birds do not mix so I put my renewed interest in birds on hold for several years until after Cassie had died. She had been such a difficult pet that I was aware of her absence for weeks, turning to see what food she was stealing, moving to shut her away when the door bell rang. I was reminded of a patient who had become sexually frigid after the death of her dog. She had lost her mother two years before. At that time, her husband had been sympathetic and she had soon been able to make love again. As she
talked about her dog it was clear that her old grief had been aroused. She had not connected the two losses and was filled with fury that she could not express when her husband said, ‘How can you be so upset about a dog?’

The year my dog died I joined a birding group to the Scilly Isles, where I met my first real birders. They keep lists of sightings in the day, the week and each year, as well as life-long lists. The first ever sighting of a new bird is very important. On that trip a couple of people had two new birds but many felt lucky to get even one. I was in the enviable position of the new girl, whose ignorance was tolerated with amused patience when I admitted that my list ran to twenty-five.

Since that time I have spent several holidays with such groups. I am not an obsessive or knowledgeable bird watcher. The appeal of scanning the boundless sky, the depth of a reed bed or the expanse of a dry, flat plain is hard to express in words. It is not the human company, for some of my happiest moments have been spent alone. Nor is it merely the thrill of recognition, with the help of the book if necessary. No, the call is to that part of me that was so moved as a schoolgirl when I found my private place in the grounds of Hinton House, where I could look out over the fields, or contemplate a leaf. Sitting in a hide or crouched by the side of a lake or estuary, the hues and contours of the countryside sink into my being. Watching the almost imperceptible change in the reflected clouds or the ebb of the water, a flutter of wings or a flash of colour tames the impersonal space with evidence of individual life.

I cannot imagine looking out at my garden and finding it bereft of birds, those fluttering creatures who decide, of their own free will, to visit me. When I was first alone that space was also made safe for me by the naval tenants to whom I let my mother’s flat. The accommodation suited sub-lieutenants, who were all married with wives and small boys living elsewhere. This meant that for most weekends they left the house on Friday morning and did not return till Monday evening, an ideal arrangement as I and my birds had the garden to ourselves.

I have kept in touch with several of these men. Chris moved in within a year of Ralph’s death. I was so grateful to him for the tactful way he ignored my frequent red eyes, making no comment but suggesting a drink by the pond, where we talked of anything but death. David came later and was a vegetarian who liked his rum. I would see him stalking across the garden to put the outside leaves of his greens in my compost. One wet weekend, when his boys were visiting, I lent him my Buccaneer, a game where you sail little boats about collecting treasure. It was an old set of Ralph’s and even though the cloth ‘board’ was very worn the treasure was beautiful. The gold bars were lead, painted gold and heavy enough to be real, the barrels of rum were made of wood and the glass diamonds and rubies sparkled. In modern sets all the treasure is plastic. The following Christmas David made his own set using half toggles for the barrels. Such imaginative dexterity warmed me with memories of my father.

After my father had died someone suggested to my mother that strangers could be helpful. She took tenants into the surgeries at Green Gables and again into the new house she built in the grounds. In my turn, I found the friendly but non-invasive company of the naval officers with whom I shared my house, and in particular my garden, helped to detoxify the grief that could have overwhelmed me. Eventually the naval establishment in Bath began to move over to Abbey Wood north of Bristol and the supply dried up. Now I am dependent on the university for tenants and have to adapt to a variety of students. I aim for those in their fourth year or studying for a PhD in the hope, sometimes realised, that they will be mature enough to need little attention from me, either in a caring or disciplinary role.

Floundering in the turmoil following Ralph’s death my work provided another safe space where the routine forced me to keep in touch with the world and my place in it. I gave up my job at the University the year after he died, but continued to have a very full diary and to drive my car a great deal. Not only into Bristol three or
four times a week to see my analyst but down into Somerset for clinics, into Wiltshire and Gloucestershire and Devon to lecture or lead psychosexual seminars. Once a year Heather Montford and I tutored on training courses for family planning trainers, often under the auspices of John Guillebaud of the Margaret Pyke Centre. The interest and pleasure of working with Heather provided some of my happiest moments since Ralph had died. Out of these experiences we conceived the joint project of editing a multi-author book.

Heather wanted to call the book
Psychological Factors in Contraception
. I insisted on
Contraceptive Care
. In retrospect, I can see that her title would have been better. The idea of ‘care’ was going out of fashion, associated with a paternalistic view of doctoring that was being challenged by the concept of more autonomy for patients. ‘Shared care’ was a phrase used, not just for sharing between different professionals but between the doctor and patient who should be allowed to make choices. In addition, the more scientific sounding name would have helped our fight to have the subject fully recognised as a special branch of medicine.

Several years passed before I understood that the decision about the title was an example of my voice being heard more powerfully than I realised. I had never considered myself to be a forceful person, one whose opinions would carry weight. Now, perhaps because I had led seminars and edited books, I caught myself holding forth and being listened to with respect. I had to step back and be more obviously prepared to change my point of view. As someone who had always believed that I saw too many sides to any question and was lacking the ability to make judgements, this required a startling re-assessment.

As my psychoanalysis progressed I began to see that I was neither as bad as I sometimes imagined, nor as good. I realised that the pervasive sense of ‘not being good enough’ was a sort of inverted snobbery that carried an undertone of needing to be better. . . better than I had been, better than my sister, better than others. I leant to accept that my position at school, hovering somewhere in the middle of the class, was about right. For the first time I could consciously
counter the awful sense of not being worthy of respect, affection or love, with a more realistic idea that I was not that bad. . . nor in any way outstandingly good.

The question of evaluating my own views and work comes to a head as I try to assess the value of
Blocks and Freedoms in Sexual Life
, the book that I wrote on psychosexual medicine and published in 1997. At the time I was reading a lot of psychoanalytic literature. This is reflected in the list of references, which my analyst said I used defensively but which I think were there for a reason.

Tom Main had died in 1990 and the IPM was in the difficult position of any organisation that loses a charismatic founder. I thought my book was needed because of the danger that the insights we had gained over our long training were being lost. Psychoanalytic theories were becoming unfashionable. During a listening consultation, where the body and mind can be considered together, the patient can sometimes break through barriers in the most surprising and rapid way, cutting short a chain of referral to different specialists, as was shown by the research into non-consummation.

Pressures were building to widen the scope of understanding and training to include behavioural ideas that were so fashionable at the time. Injections for impotence were coming onto the market, with Viagra on the horizon. Quite rightly, doctors in the IPM realised that they needed to be fully up to date with these advances. At the same time another society, which became the British Association of Sexual and Relationship Therapists (BASRT), was running multidisciplinary training meetings with a very behavioural bias. I remember being asked to speak at one meeting where the participants, including doctors, were being encouraged to take a full sexual history and give advice, both activities at which those in the medical profession are very accomplished. My own suggestion that, in a busy surgery, one needed to listen, pick up unspoken messages and follow the patient, was given a very rough reception. That association has now become the College of Sexual and Relationship Therapists (COSRT) and I am sure has a wider understanding of the aetiology and possible approaches to sexual problems.

I divided my book into three parts. The first dealt with aspects of doctoring with especial reference to the psychodynamic use of the consultation and the genital examination. The following section of the book considered various feelings that may underlie the presenting symptom. In the last two chapters I try to make more philosophical connections between the mind and the body.

The reviews of the book when it was published make interesting reading for me, particularly the one from the
Journal of Sexual and Marital Therapy
. The reviewer considered the viewpoint ‘individualistic, almost idiosyncratic’, and complained that there were no references to the behavioural literature. It will be clear to the reader that I did not value that work enough to quote from it. I was also surprised at his suggestion that this was a personal idiosyncrasy, whereas I was representing quite a large group of doctors whose work I admired. He did, however, say that the case histories were useful. Re-reading some of these now I am no longer sure which stories were taken from my own practice and which borrowed from the experience of others. All doctors working in the IPM at that time had either changed practical details to preserve the anonymity of patients, or got their permission to share their story with colleagues. In addition, I put the following sentence at the beginning of the book: ‘If any reader believes that they can recognise themselves in the histories, it is likely that they are identifying with aspects of someone else’s story. In any event, they can rest assured that no one else will be able to recognise them.’ I sincerely hope that this has proved to be the case.