Breaking and Mending Page 11

  For the next few minutes, I listened to a life lived parallel to mine. Paths never crossing, but knitted together by pocket-money stories and camping holidays, and posters pinned to bedroom walls. And as the stories unfolded, the time between Gill’s breaths became longer and longer.

  Until.

  ‘Gill hasn’t taken a breath for a long time, has she?’ her mother said.

  ‘No,’ I replied. ‘No, she hasn’t.’

  I walked over to the bed and held my fingertips against Gill’s skin. I watched for the rise and fall of her chest, for the slightest flicker of movement. We stood, the three of us, only for a couple of minutes, but it felt a forever time. I knew, even without the checks and the watching, because the air was different. The room had changed.

  ‘I am so sorry, Gill has died,’ I said.

  The footsteps on the little path outside and the sound of the ward beyond the side-room door all seemed to fade for a moment, and we were held still in the quiet. Perhaps the noise continued to be there, but the weight of the room made it unable to be heard, or perhaps Gill needed the silence in order to leave us. The next sound I was aware of was Gill’s mother crying, very softly. The crying of a person who has lost someone they love to this brutal disease – a mixture of relief at an end to their suffering and despair at what might have been. Grief for the disappearance of hope and a lost future.

  Her mother stood up and pointed. ‘Could you straighten Gill’s necklace?’ she said. ‘It’s crooked. She hated her necklace being crooked.’

  Gill was wearing a very fine chain with a small amethyst pendant. Her birthstone. My birthstone. I gently reached around her neck and adjusted it so the clasp was at the back and the tiny stone lay flat. It was the kind of thing you’d do for a friend or for your mum.

  ‘I am so sorry,’ I said, because I felt the tears overwhelm me. ‘I am so sorry.’

  There are times when you can force crying back inside you somewhere, when you can make it wait for a while, and there are other times when you feel unable to hold on to that control, when the emotion overpowers you with such force that the only thing you can do is to let go.

  The tears weren’t just for Gill. They were for the elderly couple who had just watched their only child take her final breaths, they were for the injustice and the misery and the broken system. For all the times I’d forced the crying back inside somewhere.

  ‘It’s so unprofessional,’ I said. ‘I am so sorry.’

  Gill’s mother put her arms around me. ‘You are a human being first and a doctor second, and I can’t tell you what a comfort it is knowing how much Gill meant to you.’

  There we stood, the three of us in curtained light. All crying for someone who deserved so much more of life.

  I left Gill’s parents to say goodbye and I walked back on to the ward. The light and the noise and the cruelty of an ordinary day felt like an assault. I was still crying. I wasn’t sure I would ever be able to stop.

  The other junior doctor took one look at me and lifted the bleep from my hands.

  ‘Go,’ she said, because she was kind and understood. ‘Go!’

  I left the ward and pushed through the doors on to the little path outside Gill’s room. I climbed a steep bank, where a shortcut had turned the grass into mud, and I walked to the far side of the car park. My car was the only place I could think of where I could be alone, and I sat in the driver’s seat and I sobbed. Huge, angry sobs that made my body fold and retch, and my lungs hungry for air.

  I stared over at the hospital and wondered how I had ever imagined I could do this. Perhaps it might have been possible to face the misery and unfairness inside it each day with the right support. Although there were wonderful, kind doctors working inside that building, there were also the ones who passed you in the corridor without a backward glance at your welfare, whose spit landed in your face, the ones who seemed happy to watch you fail. These were the people who walked through your mind in the early hours, who kept you from sleep, who disallowed you the joy and the privilege of your job.

  Perhaps, as juniors, they had been bullied too. Perhaps it was a family heirloom they felt obliged to pass down to the next generation, or perhaps not all good doctors are good people.

  I knew as I sat there that I couldn’t stomach another mouthful, and every ounce of self-preservation told me to start the engine and drive away. Although I didn’t know where I could go. I couldn’t return home and display my own failure and inadequacy for everyone to see, but there was nowhere else I belonged, and I wondered momentarily whether it would be easier, perhaps, just to disappear. I sat with the engine running for a long time, searching for a thread of something to keep me there. Eventually, I found it. The patients.

  Being with Gill’s parents was a job I had done well. If I managed to make the tiniest difference, if I helped to make the most traumatic experience of their lives even the slightest bit more bearable, it meant that I was learning to be a good doctor after all. (I didn’t know it then, but a week later her parents would thank me in Gill’s obituary in the local newspaper.) Gill’s death was one of the worst days I experienced as a junior doctor, but it also reinforced my decision to work in psychiatry. As a medic, you are responsible for monitoring your patient’s blood pressure and calcium levels and pain relief, but you are also responsible for monitoring their worries, their emotions and their hopes. As part of a patient history, a doctor will always ask – among many other things – about the history of a presenting complaint, about the patient’s medication and about their previous illnesses. Tagged on the end, along with drug allergies and smoking status, there is a small section in which you are required to ask about the patient’s emotions. In another of medicine’s wonderful acronyms, it’s known as ICE (ideas, concerns and expectations) and it’s often given the least time and has the shortest answers of all. Perhaps it would be better to start the consultation with ideas, concerns and expectations – and not only those of a patient, but also of a patient’s family and friends. And perhaps this section of a history should be the one that is given the greatest weight and time, because these are the things that shape both our lives and our health. This is the lesson I learned that day, and, having the privilege of meeting Gill and her parents, and waiting with them in that curtained side room, made me appreciate that medicine is so very much more than a science.

  I nearly drove away from medicine that day, but eventually I reminded myself that I was committed to this job, and I knew, no matter how I felt, that I had to go back inside. To desert the patients was unthinkable. To walk away from an obligation and a promise wasn’t an option, no matter how desperate I was, and so I walked again along the little path and through the double doors and the ward where Gill’s parents still sat with their daughter. I walked along corridors, past porters and nurses and medics and their ordinary days, past the clattering of laundry trucks and the wheels of patient trolleys, and through the swing doors of A&E. I took the first patient notes from the desk and I sat in a cubicle, behind paper-thin curtains, listening to the rest of the hospital happen around me. My hands shook and my eyes swam with too much seeing, and I wondered how someone could walk through a landscape and be at the very lowest point of their life and yet no one who passed by them even noticed.

  I had two weeks annual leave.

  It had sat in my pocket for the longest time, and I had almost given up being able to take it. Because there were so many gaps on the rota, it was down to us to find someone to cover our shifts if we wanted to take a holiday to which we were entitled, and it was almost impossible. Days were lost, much-needed breaks slipped off people’s calendars and disappeared, but, as I worked through my shift in A&E that day, I knew that I had to find some way to escape, even for a short while. If no one was prepared to help me, I had to help myself, and through bribery, promises and sheer determination, I eventually managed to put it in place. I had my fourteen days to recover.

  During those fourteen days I didn’t go on holiday. I didn�
��t fly anywhere exotic or even book a little cottage by the sea. I just did what I love doing the most. I read. I did nothing but read. From the minute I woke, to the minute I went to bed. Thrillers, classics, poetry. Plays, autobiographies, essays. I filled my mind with other peoples’ words and thoughts, as many as I could, and at the end of those fourteen days I had read sixteen books.

  I strongly believe in the power of words to heal and mend. We read stories to make sense of the world, to better understand our own situations and challenges. Every story we read follows a template, a prearranged agreement between author and reader that states that, despite many obstacles, the narrator will ultimately succeed on his journey, and the villain will eventually get his just desserts. We expect this. It’s part of the deal. When we read the last page of a book, we feel safe in knowing we will be given our happy ending, even if that happy ending isn’t always the one we might expect it to be.

  We have followed this template since we were children, since the very first time we were told a bedtime story, and we take it with us into the real world, perhaps subconsciously hoping that the template will work out there too. It doesn’t, of course. The obstacles faced by many of my patients weren’t surmountable and none of their last pages felt like a happy ending. Perhaps our constant despair at the world, at the politicians, the deep lack of humanity and the many injustices of society, is felt more sharply because it fails to fit into the template we’ve believed in for so long.

  Perhaps this is why reading is so important, because in reading we restore the possibility of hope.

  After my two weeks were over, I prepared myself to go back to the wards. This time, however, I wasn’t jumping back into the turmoil of general medicine or surgery. Instead, I was heading where I had wanted to work since the first day of medical school, and perhaps even before that – since I delivered pizzas and typed letters, and chased people around department stores. Since before I dared myself to see if I was smart enough to be a doctor.

  I was heading to psychiatry.

  I had looked forward to this moment all the way through medical school. I had tried to focus on it as I walked through the agonies of my previous rotations. It was the whole reason I was there in the first place. Yet still the misery I had endured in the previous few months lay shallow at the surface and I decided I would give it a week. If, after a week, I felt the misery creeping back, I would unfasten myself from medicine forever. No matter the shame and the humiliation, and no matter the inevitable chorus of ‘I told you so’. I would give it a week. One whole week.

  I was there almost a year. Until the junior doctors’ rotas changed and I was forced to say goodbye.

  Psychiatry rescued me.

  Minds

  I have heard voices since I was a child. I used to think everyone did, until I got older and realised something was wrong. I’ve been in hospital more times than I can remember, and I’ve been sectioned on four occasions. I don’t remember some of the admissions. Perhaps moments of them, but then it feels like looking at a photograph of yourself and not remembering how it came to be taken.

  I always remember when people were nice to me, though. Daft things, really. When someone lent me their phone charger or gave me their chair in the day room, because they knew I liked to sit next to the window. Nurses who listened to me. Doctors who cared. I hold on to those moments when I’m ill, because when your life is filled with bad things, you have to keep polishing the little pieces of good just to keep you going.

  The patient

  On my first day in psychiatry, after we had done the patient reviews and gone through the drug charts, and I had typed up the discharge letters, I asked how I should spend my afternoon.

  I was still smarting from my experience in general medicine and was determined to show I could be a good doctor. I wanted to make a decent impression, to give this job the best shot I could before I admitted defeat; before I finally threw in the towel for good.

  After a brief pause, I was told I should talk to the patients.

  I had just spent a year being told that I talked to the patients too much.

  The relief was unimaginable.

  Of all the underfunding in the NHS, it is most noticeable by far in mental health services. Perhaps that’s because here you often find people who have nothing to begin with. While patients I had met before usually had a framework of people they could rely on – to make sure they took their medication, to do a bit of shopping for them until they were back on their feet, to stand their corner, or just talk to them – there were mental health patients, thanks to a life spent largely being ignored and excluded, who had no one. Not a soul. I met one woman with schizophrenia who said that she’d stopped taking her medication because it took away the voices she heard, and they were the only ones keeping her company.

  When the embroidery of life is taken away, when those who support and bolster and underpin are removed from our picture, and we are standing completely alone, only then does the true effect of isolation become apparent, and the NHS is left to deal with the consequences of those losses. The small spaces where people used to find comfort and companionship. The libraries. The coffee clubs, the inner-city projects and the village halls, all cut away and vanished, leaving whole armies of people with nowhere to go. Without these spaces, communities themselves eventually fragment and disintegrate. Whereas once we would notice if someone in our neighbourhood was struggling and unable to cope, now roads and avenues unfold endlessly across a landscape and houses are filled with people we neither meet nor care about.

  ‘Nobody on my street knows my name,’ said one patient. ‘No one would even notice if I disappeared.’

  Some of the patients on a mental health ward have spent their lives drifting unanchored, existing alongside serious illness without support or even acknowledgement, until one day that serious illness causes them to catch and snag on a corner of society, and the rest of the world becomes aware of it. Sometimes, the catch is small and manageable. Sometimes, it is not. Sometimes, the unmanageable is caught just in time, like the accountant who stood on a train platform and heard the voice of God telling him to push a stranger on to the tracks.

  ‘I wanted him to die because he’s part of The Club,’ the accountant said. ‘They’re after me. They’re everywhere.’

  His eyes pleaded for something and his voice carried with it a question, and I wasn’t certain if that question was a need for acknowledgement or a need for a release from the person his illness had forced him to become.

  Sometimes the unmanageable isn’t caught in time and this is when we see hysteria and screaming headlines, as society forgets that the patient and the illness are not as one, and we blame the person when we really should be blaming our own failure to notice when that person is first in need of help.

  Others on mental health wards seem to arrive from nowhere, from quiet, anchored lives, from suburban houses on leafy streets where you wouldn’t imagine mental illness would wander at all. The first thing you will notice as you walk on to the ward is a gathering of people from all backgrounds and from all circumstances. There are those without homes or jobs, and those with families and professions. Those who have lived with mental illness their whole lives and whose notes span several volumes, and those who find that one day they are suddenly no longer able to cope with whatever life has delivered to them. It is also fair to say that on every mental health ward and in every psychiatry outpatient clinic, you will find a huge army of midwives, doctors, nurses, pharmacists and social workers. You will find the NHS, stretched to its very limits.

  The second thing you will notice as you walk on to the ward is that all those people, and all their variety of backgrounds, have become a community. There is often tension and argument, and the dynamic changes with each new admission, but similarities are celebrated and differences are forgotten. Patients support each other. Friendships are made. Perhaps thrown together by chance and circumstance, unity is built out of diversity and the ward supplies what soci
ety has so often failed to provide – a sense of belonging.

  I could feel it as soon as I arrived on my first day, as soon as I pushed open the double doors and walked on to the ward, and I knew instantly it would provide the very same thing for me too.

  So many nurses are extraordinary, but I have never met more extraordinary nurses than I did in mental health.

  Not just the nurses, either. The support workers, the occupational therapists, the social workers and the volunteers. The doctors, the ward managers, the pharmacists, and the speech and language therapists. An entire population of people whose only purpose in life is to give a patient back their self-belief, and to rescue a life worth living. So many times, I saw small moments of compassion – so fleeting, so transient, they could easily have gone unnoticed. If I told them here, they would seem insignificant and they would be lessened by the telling, but to watch them across a ward or a day room took my breath away. Because those moments reminded me of the kindness one human being can show to another, to a stranger. This kindness is nothing to do with wearing a uniform or holding a stethoscope. It’s to do with being human, and in psychiatry, I began to witness the very best of humanity.

  Miracles

  Psychiatry is probably one of the most significant two-way processes in healthcare. You can see such a change and it refreshes and re-energises you as much as the change benefits those you work with. The emotion that can break your heart is sometimes the very one that heals it.

  The mental health nurse

  If medicine is a book of stories, psychiatry holds the wisest chapters and the ones from which you will learn the most.

  Within each patient narrative is an opportunity to understand – not just about the illness, but about wisdom, humour, life and people.