Breaking and Mending Read online

  I was fortunate enough to do two back-to-back rotations in the same job, but that morning happened to be changeover day for everyone else, and a new doctor walked into the handover. I peered at him over my coffee as he was introduced to us.

  ‘This is Dr Smith,’ said the consultant. ‘Dr Smith is a Foundation Year 2 doctor. He has more experience than Dr Jo.’

  I tapped my finger on the arm of my chair and a bristle of irritation wandered around the back of my neck. Dr Smith smiled at the room. He even did a small bow. He was a good ten years younger than me. He wore a crisp white shirt and a tightly knotted tie, and around his neck was an expensive and very shiny new stethoscope. I thought of the patients next door. I wondered how this was going to work out.

  In our first lecture on the first day of medical school, as we were welcomed into our medical career, we were also told something else – something I would perhaps argue about now, but something which broadly makes sense. We were told that there are two kinds of doctor: white coats and cardigans. Those who love the science and those who love the people. Those who order tests for the patients and those who talk to them. Using those (debatable) parameters, I was so much of a cardigan, I was off the scale. Dr Smith, however, was born and bred in a white coat. He had travelled from A-levels to medical school and into being a doctor without taking a breath. I was the wild card. I had taken so many breaths, I was surprised there were any left to go round. Still, the consultant was right. It was true, Dr Smith was more experienced. He was a Foundation Year 2 doctor. He was a year ahead of me on this journey, after all.

  We muddled along. If there were new people to clerk, I would take the histories and Dr Smith would take the bloods and the ECGs. In the afternoons I sat in the day room, chatting to the patients, while Dr Smith sat in the doctor’s office, working on his audit. Occasionally, he would appear and hesitate for a while at the edge of the room.

  ‘Why don’t you join in?’ I’d say, later.

  ‘I don’t know what to say to them.’

  ‘Them?’

  ‘The patients.’

  ‘Just have a regular conversation.’

  He frowned.

  ‘Talk about the same things you’d talk about to anyone else,’ I said.

  He still frowned.

  The patients were a mystery to him. The only problem was that the patients soon cottoned on to this. They invented physical ailments for him to investigate, only to give him a psychiatric history when he tried to examine them. They made fun of his stethoscope. They regularly coaxed out his awkwardness and used it for entertainment. I became tired of rescuing him, partly because he constantly built his own gallows but also because there was a strange sense of satisfaction in watching someone else play the wild card for a change. Shamefully, the more Dr Smith floundered, the more secure I felt in my own foundations. Besides, he should be able to rescue himself quite easily. He was, after all, I told myself, far more experienced than I was.

  A few weeks after Dr Smith’s arrival, we were both assigned to a new patient as a case study.

  She was a young woman, with no history of mental health problems and no prior engagement with mental health services. She had previously been very quiet and reserved. A hard worker. Few friends. Living an unremarkable and un-extraordinary life. However, during the course of one chaotic weekend, and completely out of character, she had stolen a car and driven many miles (without a driving licence) to an unconnected town in the north of England, where she began screaming and shouting at people walking around the shopping centre and threatening violence to anyone who approached her. She was brought in by the police. She refused to speak to any of us.

  Dr Smith and I were quite puzzled. I tried to talk to her, but each time I did, she would just walk in the opposite direction. Dr Smith didn’t even make an attempt. She didn’t speak to any of the staff, or to any other patients, and for the most part she would sit in her room staring silently into the walls. Her parents said that, in retrospect, she had become more withdrawn in recent weeks but that there had been no trigger, no inciting incident. There was no trail of breadcrumbs for us to follow.

  Her parents visited each day and we relied on them to piece together a narrative. She refused to speak to them, sometimes sitting at a different table, at other times staring beyond them and into the gardens. Still they came. They brought gifts and food and trinkets from home to make her feel more comfortable.

  ‘Your parents are so lovely,’ I said to her one day, as Dr Smith and I walked back to the ward with her after visiting hours.

  I didn’t expect a reply, but she turned to me. Since her arrival, it was the first time she had even acknowledged that anyone had spoken to her.

  ‘My parents aren’t really like that,’ she said very firmly.

  I glanced at Dr Smith.

  ‘Yes, but don’t you think it’s a strange thing to say?’

  Dr Smith and I were sitting in the office a few minutes later.

  ‘Not really,’ he said.

  ‘My parents aren’t really like that,’ I repeated. ‘It’s just an odd way of describing it.’

  ‘She probably meant they’re putting an act on because we’re there.’

  ‘But that’s not how it sounded,’ I said.

  The next day, I marched into ward round. I’d spent the previous evening wading through textbooks looking for answers, and I believed I had found one. I was explaining myself even before I’d taken off my coat.

  ‘I know what’s wrong with her,’ I said, struggling with a sleeve. ‘I’ve worked it out!’

  My consultant raised an eyebrow. Even Dr Smith raised an eyebrow.

  I explained the conversation we’d had the previous day, the way she’d talked about her parents. The strange words she’d used. ‘I think she has Capgras Syndrome!’ I said.

  My words of triumph disappeared into a silent room.

  Capgras Syndrome is a delusion whereby a person thinks that someone close to them – their spouse, their parent, their child – has been replaced by someone else. Someone who looks and sounds exactly like that person, but who is, in fact, an interloper, an imposter.

  Capgras Syndrome is very rare.

  ‘I never thought I’d say this to anyone, but I think you’ve been reading too many textbooks,’ said my consultant, and I could see Dr Smith smirk ever so slightly, ‘but I’ll talk to her.’

  He talked to her and it turned out that she did believe her parents weren’t really her parents. She thought they were actors, manipulators, fraudsters. She knew for a fact that these people weren’t really who they were pretending to be, and – of course – the next step from realising they were impersonators was to destroy them. She was quite willing to discuss this, quite happy to talk to us, it was just that we hadn’t asked her the right questions before now, and as luck would have it, I happened to hit upon the right question in that corridor.

  ‘And you knew all this from that one sentence?’ said Dr Smith later, when we were writing up the notes.

  Perhaps it was luck or just good fortune that I happened to pick up on what the patient was really thinking, but I like to think that the more you listen, the more you hear. If you hear enough stories you will come to know where a beat is missing, where a pause takes the place of a word. You don’t have to be a doctor to hear those stories. You’ll stumble across them as you’re pulling a pint or waiting a table. You’ll find them in conversations in a department store and in the queue in a supermarket. The more stories you hear, the more you realise that people always choose their words with care, and words are chosen for a reason. It is, perhaps, something that you learn only with experience.

  At the end of the rotation, Dr Smith and I went our separate ways. I went on to another job in psychiatry and Dr Smith disappeared beyond the horizon. If you are worried about him, please don’t be: he found his niche, as I had found mine. A year or so later, we crossed paths again in A&E. He was still wearing his crisp white shirt and his tightly knotted tie, and arou
nd his neck the stethoscope still looked new and shiny. He was working with the orthopaedic team. He smiled at me as we passed each other.

  Dr Smith was no longer a wild card. He looked the most comfortable he had ever been in his life.

  Mending

  For all the breaking and mending of this profession, it has allowed me to live a life worthwhile. For all the breaking and mending, it has helped me to edge closer to the doctor I wanted to be, the doctor that I still want to become. Because there will always be a need to learn, to improve and to change, very much as I was told on that first day at medical school.

  Most important are the words I heard in the past from many people I respected, often on retiring from professional practice, and the same words were very recently echoed by a new friend: let’s remember to check in with colleagues that they are okay – because this is what communities do.

  The consultant

  Many times during my training I would say to myself, and to anyone who would listen, that I wished I had never done this. I would wish that I had taken a different path, that I’d never seen the postcard in the newsagent’s window and I’d never persuaded a doubtful professor that I would make a good doctor. I would go to great lengths to list all the other jobs I could have done instead. The many careers that would not have left me mentally, physically and financially exhausted.

  Now, I look back and I can’t imagine having done anything else. I can’t imagine not meeting the incredible people I have had the privilege to meet, and I am amazed at the fragile decisions I made that allowed our paths to cross, even if it was only for the briefest of times.

  One of my deepest concerns about writing this book was that it would deter people from following a career in medicine. If it’s any help to those who might be considering becoming a doctor – I truly wouldn’t change a thing, even the darkest days, even the days that made me question whether my existence as both a doctor and a human being was really worth anything at all. Because of all the days I had, those were the ones that taught me the most.

  Mending, like breaking, can happen in the unlikeliest of places.

  It can grow from the briefest event and from the shortest encounter. Breaking is accumulative. We collect small episodes of despair and unhappiness, our own Kodak moments, and we carry them with us until their weight becomes too much to bear and we fracture under the burden. Mending is exactly the same. The more often we witness small moments of compassion, the more humanity we see; and the more likely we are to be able to mend ourselves and the quicker we are to heal.

  At medical school, we had many lectures devoted to mending: the anatomical, physiological and biochemical methods of healing, of bone and skin and tissue, from infection and fracture and disease. We learned about the complex process of clotting and the coagulation cascade, the direct and indirect wisdom of bones, the acute inflammatory response and the intricate expression of many thousands of genes. The body’s ability to regenerate is remarkable and extraordinary, but it is also intensely fragile and the most important factor ensuring its success is the correct environment. Without the right landscape, none of this can happen. In the wrong surroundings, our body itself becomes a wild card.

  When I look at the lives of the people I met in that lecture theatre on the first day of medical school I see many different landscapes. I see surgeons and GPs, anaesthetists and paediatricians. I see those who travelled halfway around the world to follow their career and those who stayed in the hospital where we walked as medical students. I see those who remain working within the NHS and I see those who left and continue to use their skills to help people elsewhere. I agree with many things we were told in that inaugural lecture – it really was the first day of our medical career – but I disagree that there are only two kinds of doctors. I think there are as many doctors as there are people, and as many different landscapes as there are ways of healing.

  Psychiatry became my landscape, and within that landscape I learned many things. I learned about the compassion one human being can show to another and I learned about the resilience of the human spirit. I learned that our roles in life are many and valuable and I learned about healing. I learned about the need to look out for each other. I learned about the importance of wild cards.

  In a game of cards, the wild card has no suit or colour. It possesses no value. Its currency and worth is determined only by the person who holds it. Wild cards are defined by their landscape and by their keeper, and what is high in value to one player, may be worthless to another. What appears to be a wild card on the surface may, in reality, be anything but.

  I am often asked about going to medical school at a later age, about being different, about being a wild card. I always say that the world – and especially medicine – needs more wild cards, but perhaps, if we look more closely, we will discover that we are all different, we are all wild cards. Perhaps each of us is just searching for the right landscape and for our somewhere to belong, searching for the right place to tell our stories, in the hope that someone out there will listen and we will be understood.

  Author’s Note

  My reactions and experiences in this book are based on real events, but the events themselves and the individuals and places involved have been changed to protect the identity of both staff and patients. Details of situations and the people I have met and cared for have been merged and altered to further protect privacy and confidentiality.

  Any similarities to particular individuals or events are both coincidental and unintentional.

  Acknowledgements

  Without my agent Susan Armstrong and my editor Francesca Barrie there would be no Breaking and Mending. A very big thank you to both of them, for their kindness, patience and wisdom, and to everyone at C&W and at Profile Books and The Wellcome Collection for believing in my story.

  All the thoughts and opinions in this book are my own, but many people have shaped those thoughts and opinions and have helped to make walking this road so much easier. With thanks to the University of Leicester Medical School for believing in a wild card, and with special thanks to Professor Stewart Petersen, Dr Jonathan Hales, Dr Mark McCartney, Dr Tony Dux and Dr Amanda Jeffery. Your teaching and encouragement made stumbling through the back of the wardrobe and into Narnia an infinitely smoother process. To Dr Amy Adams and Dr Cate Bud, who made Narnia a very much nicer place to be. To Dr Chloe Spence, who always understood.

  With huge and grateful thanks to Professor Wendy Burn, Dr Kate Lovett, Dr Regi Alexander and everyone at the Royal College of Psychiatrists for your incredible support and for allowing me to be a part of something I thought I would only ever dream about.

  To all the incredible NHS staff I have had the privilege to work with, and, always, to the George Bryan Centre for rescuing me.

  To all the friends and colleagues who have given their time and words to these pages. To Dr Claire Barkley for answering my many questions on psychiatry and junior doctor welfare, and for providing one of the most interesting conversations I have ever had. To Dr Ignasi Agell for his words and his guidance, and for being the doctor I would like to have become.

  Most of all, to the patients. You will always walk with me.

  If you have been affected by any of the issues raised in this book, you might find the following resources helpful:

  Samaritans

  Provides confidential emotional support for people who are experiencing feelings of distress or despair.

  Phone: 116 123 (24 hours a day, seven days a week)

  www.samaritans.org

  Mind

  Provides advice and support on a range of topics including types of mental health problem, legislation and details of local help and support in England and Wales.

  Phone: 0300 123 3393 (weekdays 9am–6pm)

  www.mind.org.uk

  Nightline Association

  A listening service open at night run by students to support students.

  www.nightline.ac.uk/want-to-talk/

  Pancreatic
Cancer Action

  Aims to improve survival rates and quality of life for patients.

  pancreaticcanceraction.org

  FOR DOCTORS

  The Doctors’ Support Network

  Peer support for doctors and medical students with mental health concerns.

  www.dsn.org.uk

  BMA Wellbeing Support

  24-hour counselling available to any UK doctor.

  www.bma.org.uk/advice/work-life-support/your-wellbeing

  Practitioner Health Programme

  24-hour text based crisis support available for any doctor in England.

  https://php.nhs.uk/

  WELLCOME COLLECTION is a free museum and library that aims to challenge how we think and feel about health. Inspired by the medical objects and curiosities collected by Henry Wellcome, it connects science, medicine, life and art. Wellcome Collection exhibitions, events and books explore a diverse range of subjects, including consciousness, forensic medicine, emotions, sexology, identity and death.