Breaking and Mending Read online

  And the cardiologist brought the woman back to life.

  In a fusion of machinery and drugs and experience, her heart began to beat again. The cardiologist had managed to pull her away from wherever she had gone and bring her back into the world. She was resurrected. It was fast and clean. It was uncomplicated. The woman even tried to stand up (no, really). It was the first crash call I’d witnessed and I was mesmerised. I thought all crash calls would be like that (they are not). The woman was taken to somewhere more appropriate than a cubicle in an assessment unit and the floor was cleared of debris. The cardiologist turned to his audience and said ‘she was right about the impending doom, wasn’t she?’ and he disappeared again behind a curtain – where I heard him apologise to his patient for leaving so abruptly, because cardiologists always seem to possess an impeccable sense of timing. The department carried on.

  I did not, however, carry on. I was transfixed by what I had seen. I wanted to ask the cardiologist how it felt – how it felt to return a life to someone. How it felt to do a job where you could, at any moment, become a hero. How it felt to argue with God. But I didn’t. I didn’t ask him any of those things, because I had learned very quickly that in medicine and surgery, unless you enjoy being looked at in a very curious way, you do not ask people how something feels. Instead, my gaze followed him around A&E for the rest of the afternoon, and, whenever I spotted him, I thought: ‘there is the man who saved a woman’s life. There is the cardiologist. There is a hero.’

  On that first day of medical school, if you had asked someone what their chosen specialty was going to be, cardiology would have been a very popular answer. ‘It’s the prestige,’ people will tell you, because in medicine, there is a certain hierarchy of body parts, which I have never quite understood. When it comes to kudos, hearts trump brains, brains trump bones, bones trump skin. Kidneys would, of course, trump everything, but they’re far too clever to involve themselves in such shenanigans. All I’d ever wanted to do was psychiatry (it was the whole reason I was sitting in that lecture theatre in the first place) although I would, in time, glance with awe at some of the other rotations as I passed through – the grace and compassion of palliative medicine, the utter joy of care of the elderly. But at the end of a very long road, I knew that psychiatry was waiting for me, and knowing that was sometimes the only thing that kept me going. As I travelled that road, though, I would sometimes remember the cardiologist and I would feel a whispering of regret that I would never know how it felt to kneel on the floor of an A&E department and to save someone’s life.

  It was only much later, when I finally reached the end of my journey, that I learned something vital. Perhaps the most vital thing you can ever learn as a junior doctor. I learned that saving a life often has nothing to do with a scalpel or a defibrillator. I learned that lives are not just saved on the floor of an A&E department or in a surgical theatre. Lives are also saved in quiet corners of a ward. During a conversation in a garden. On a sofa in a TV room, when everyone else has left. Lives can be saved by spotting something lying hidden in a history. Lives can be saved by building up so much trust with a patient, they will still take a medication even if they don’t believe they need it. Lives can be saved by listening to someone who has spent their entire life never being heard.

  I learned that returning a life to someone very often has nothing to do with restoring a heartbeat.

  Bodies

  Friendships from medical school remain intense despite the distance and our different stories. The friendship of those who were with me when I first saw a cadaver. Those who suffered with me from every illness we studied. Those who were with me when we first asked someone about their illness, or to undress in order to perform an examination, with a mixture of shyness and arrogance. This was our introduction to the privileged moments in people’s lives that became our routines. These friendships helped us to navigate new encounters with pain and distress, and with joy. These encounters started to shape us as doctors in more ways than one, although we were still unaware of the dark corners of that new shape, still unaware that some of those friendships, and new ones, would eventually help us to shine light into those dark corners.

  The consultant

  I called them my Kodak moments. The small snippets of other people’s lives that I took home with me every night. I collected many Kodak moments over the years and they filled album after album in my head. So many albums, in fact, that I soon began to wonder if I was cut from the right cloth to practise medicine after all.

  If you walk a circuit of any hospital, you will find many of these Kodak moments in wards and clinics, and hidden behind the curtains of anonymous cubicles. If you wish to hunt them down, you will find plenty in intensive care and in A&E. Oncology usually has its fair share, and palliative medicine is swimming with them. Many Kodak moments, though, are found where you would least expect them to be – not held within the main story, but hidden at the edges of the narrative – because it’s often the smaller moments, the incidental characters, that provide you with the memories that are the most difficult to leave behind. Whenever I expressed concern at how these moments affected me, I was always told that compassion is a wonderful thing. I was told compassion is something to be desired and applauded. But compassion will eat away at your sanity. It will make you pull up in a lay-by on the journey home, because you can no longer see the road for tears. It will creep through your mind in the darkness, and keep you from your sleep, and you will find that the cloth from which you are cut will begin to suffocate you.

  It didn’t take very long for the albums to begin filling. Exactly a week after sitting in a darkened lecture theatre and being welcomed into my medical career, I experienced my very first Kodak moment.

  It was waiting for me under a cloth in the dissection room.

  Anatomy, like many other things in life, is better learned by experience, rather than by reading about it. No matter how colourful and detailed the diagrams were in the giant textbooks we carried around, they were no match for seeing something in real life, and many of us had chosen our medical school purely because it conducted what is termed full body dissection. This means that you have a whole person to explore throughout your training. It is also the same person, the same cadaver, that you keep for your years as a medical student, and, as is tradition – and as many hundreds had experienced before us over the decades – we were introduced to ‘our’ cadaver in the very first week of medical school.

  I knew it was coming. I had seen it creep towards me on the timetable. I felt prepared. Almost indifferent. I would be fine. It was animals that tore at my heartstrings, not people. I could deal with people. Although I was soon to discover that I actually couldn’t deal with people very well at all.

  Our first dissection was scheduled for the early afternoon and we gathered in the basement of the medical school, in our fresh white coats. Few of us had eaten any lunch. We drifted into clusters, small white knots of anxiety and apprehension, bravado and curiosity. The armour of dark humour, with which I would soon become very familiar, began to creep around the edges of the room. I dug my hands deep into the pockets of my coat and tried to concentrate on the opportunity I was being given to learn, and the generosity of those who had donated their bodies in order to provide me with that opportunity. After what felt like a lifetime, we were ushered into the dissection room itself.

  It was the aroma, more than anything. A unique blend of chemistry lab and death. The strange rubbery smell of preservative. More than that, though, it smelled of history and of tradition, because, as medical students, we were walking into an experience unchanged for almost three hundreds years, except that dissection was no longer held in giant auditoriums, and graves were no longer robbed for the privilege.

  Within the dissection room there were many tables, and upon those tables were clean blue sheets, and beneath those clean blue sheets lay dead bodies. We were split into groups and I stood with six others around our table. Our body. There then b
egan a health and safety lecture, a new accessory to a three-hundred-year-old tradition, and as the words floated above my head I stared at the clean blue sheet and I wondered who might lie beneath it.

  I thought of the last dead person I had seen, only a few months earlier. I had watched as my mother said goodbye to my father on a watery, pale, February morning, surrounded by the equipment you are loaned when someone dies at home. The hoists and the commode, and the bottles of Oramorph, the monitors and the Macmillan nurse, all crowded into your front room and trying so very hard to blend in with the furniture of an ordinary life.

  You imagine when a doctor arrives at your bedside, or sits across a table from you in a consultation room, that they are somehow swept clean of their own reference points. The corners of their minds are tidied and orderly. They are unaffected by memory, or by difficult emotion, or by fracture lines caused by lives lived outside of that encounter. Another assumption. Another necessary fallacy. Because all I could think about, waiting in that dissection room and staring at the blue sheet, was my dad. I played out different scenarios in my mind as we were told about fire exits and suitable foot-wear. I thought about the consequences of leaving, and the potential outcomes of staying. I thought about how hard I had fought to be standing there and what other people might think of me if I walked away. Mainly, though, I thought about my dad. My mouth was dry. My pulse charged. My legs felt undecided about whether they wished to carry on with the job of holding me upright. I turned to the nearest person who looked as if they might be in charge of something and I explained. They listened and they understood. They told me to leave – and I left.

  I staggered back through the medical school and into the sweet, fresh air of Lancaster Road, which did not smell of rubber or chemistry lab, and I sat in my car and I tried to find my breath again. I had failed. The first challenge medical school had offered up to me and I had snapped and broken. Even worse, it felt as though the dissection room had been an initiation, a ceremony almost. A rite of passage. While my future colleagues were still in that basement, transitioning into doctors, I was sitting in my car watching the rain hit the windscreen, and wondering why I had ever imagined I could do any of this in the first place.

  Over the next two weeks, I tried many times to enter that dissection room. I ventured into the basement when no other students were around, thinking the solitude might help me to acclimatise to death. It didn’t. I went down there to speak to one of the anatomists, perhaps looking for a little empathy, a little understanding. She explained to me the importance of dissection in the same language as the glossy pages in a medical school brochure, but I didn’t listen because I was too busy staring just beyond her right shoulder, at a polythene bag containing twelve severed heads. I nodded and walked away. I even went to my GP, thinking I could medicate myself into facing up to it.

  ‘I don’t think I’m cut out for this,’ I said. ‘I don’t think I can carry on.’

  She stared at me. ‘But you must. Especially now.’

  I looked up at her from deep within my tearful, self-absorbed misery. ‘Why?’

  ‘Because the way you’ve reacted to the dissection room tells me what a good doctor you’ll make.’

  I didn’t feel like I’d make a good doctor. I felt fraudulent. Ridiculous. As the dissection room rolled around each week on the timetable and as I rolled neatly away from it, I knew I had to either throw in the towel right there and then, or address it before it became insurmountable.

  Along with the dissection room and genetics and physiology and pharmacology, and many other new and mysterious subjects, one of the topics we were presented with in our first semester at medical school was pathology. The registrar who taught us was around the same age as me, and she was funny and wise, and spoke with such passion and enthusiasm about her subject when she was with us that she made everyone in that room want to be a pathologist. She was also one of those rare people you couldn’t help but instantly like, and in another of my moments of wild spontaneity, I decided to ask if I could accompany her to a post-mortem. Surely if I saw front-line anatomy in one of its most useful roles, solving puzzles and providing answers, it would help to rid me of my fears. But I was a first-year medical student. I had (quite literally) just walked in off the street. She would definitely say no, which was just as well, because if I couldn’t face the clean, bloodless, preservation of a dissection room, how on earth would I have coped with an autopsy?

  She said yes.

  Choices

  Whenever you visit a hospital, your destination is always clearly marked. Signposts are suspended above your head along all of the corridors. Arrows are painted on to floors. Colourful you are here! maps are drilled into walls. Everything is described, pointed out. You can’t possibly get lost, at least in theory, because the purpose of every department is made clear to you and on each door hangs an explanation.

  The door I was looking for, however, did not possess an explanation. It sat by a reception desk in a small corner of the hospital. It did not have a sign or a purpose drilled into the wall, and should you happen to have noticed it as you walked by, you might have imagined that it led to a stationery cupboard or a small cloakroom. It was the door to the mortuary.

  For my time at medical school, I had chosen to commute each day, and during that morning’s long drive of one hour and forty-five minutes I had played the radio on an especially high volume. It was a distraction, filling my car and my head with the lyrics to songs. I didn’t know it then, but a few hours later, I would return home without the radio on at all. Music would eventually become a barometer, used as a diversion or as a comfort. Its absence denoted an especially difficult day, when I needed the quietness in order to process my own thoughts, and there would be many times when I would drive the entire journey home in absolute silence.

  Once I had found the unmarked door, I walked through and was immediately faced with a labyrinth of corridors. In offices on either side, secretaries typed behind towers of patient notes. People passed by me with mugs of coffee and quiet conversation. Everything felt so ordinary. I walked down more corridors, through more unmarked doors, each progressively harder to negotiate, like a real-life but sobering computer game. Swipe cards. Keypads. Codes I had written on pieces of paper were carefully pressed into silver buttons. I became stuck between two doors and had to be rescued by a man in scrubs, but eventually, I arrived at my destination – the mortuary, where I was met by my registrar.

  ‘You made it,’ she said.

  I think she was as surprised as I was.

  The changing room in the mortuary felt reassuring, with its quaint and nostalgic air of a childhood trip to the swimming baths. There were wooden benches and a tiled floor. Rows of lockers, most unlocked and gaping open, were filled with photos and stickers, personalised mugs and spare cardigans. Post-it notes of lives lived outside the hospital. Just like at the swimming pool, there was even a little walk-through area, but instead of being filled with a chlorine solution, pressure hoses and scrubbing brushes hung on its walls. I was given protective clothing, which I expected, but added to that were goggles and wellington boots, and giant rubber gloves which reached right up to my elbows. I stared down at my new outfit and wondered what might lie ahead that made it a necessity.

  My registrar turned to me. ‘We’re now going through those doors.’ She pointed. ‘Beyond those doors are three tables and on those tables are three bodies, all at different stages of a post-mortem. The body we’re working on today is on the far right.’

  I stared over at the doors and I felt the familiar tread of anxiety creep from my stomach and into my throat.

  ‘It’s perfectly normal to respond to it. It’s perfectly normal to feel anxious or upset, or to want to leave,’ she said. ‘You can leave at any time. Just walk back through those doors and you’ll be in the changing room again. No one will mind. No one will think any less of you.’

  And with those words, I knew I would be okay. Because with those words, the regi
strar handed me something very rarely given to us in medicine. She gave me permission to react. Permission to experience emotion and distress, and to acknowledge my own feelings. On so many occasions we are expected to remain impassive, to be mechanised and empty, programmed and preset to be unresponsive to all the unhappiness and misery we encounter. This disapproval of emotional reaction exists in everyday life too. Certain corners of society maintain a particular distaste for anyone displaying emotion, anyone who admits they are overwhelmed or unable to cope. Newspapers and magazines devote a special place on their front pages to any celebrity who cries in public, especially if that celebrity is a man. We are expected to somehow absorb our feelings and our responses to life, to banish them far from the surface of who we seem to be, because their disappearance makes it so much easier for everyone else. In medicine, it’s seen as almost mandatory.

  ‘You’ll be fine,’ said the registrar.

  I was fine.

  Of course, what I saw beyond those doors was undoubtedly shocking. My first reaction was that I must be on a film set or backstage at a television show, because the scene in front of me was so far removed from anything I had ever witnessed, and my brain was unable to process it. My eyes needed distance at first, and I prowled at the edges of the room. I wiped my very clean goggles. I adjusted my perfectly placed gloves. I did anything but look at the thing I was there to look at. It’s amazing, though, how quickly we are able to adjust and within a few minutes I was at the side of my registrar (who, because she was very wise and very kind, had allowed me to prowl and adjust, and wipe my very clean goggles, without comment).