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Monday, June 29, 2015

The Making of a Child Psychiatrist (1)

The Making of a Child Psychiatrist (1)
Chapter One: Earliest Days
I have always been fascinated by people; how they get to be who they are and what makes them manage their lives in the way they do. From the age of 12 I went to a grammar school in Kent, and had to travel by bus from Westgate on Sea to Margate (about 3 miles), changing buses at Margate Harbour to get to Ramsgate (about 5 miles), the whole trip taking about an hour. Most people look out the window and admire the never changing view, or they bury themselves in a book. I watched people as they got on the bus and found their seat, settled into temporary relationships with the person next to them, or continued a conversation from earlier on with a loved one. I wondered who they were, and fantasised about their lives. Why were they laughing? What had made them angry that morning? What were they feeling when they reached up to a partner’s hair, tucking it under a woollen hat? Of course there were some young people travelling the same bus, but I was less interested in making relationships and friends than observing strangers. This has probably continued throughout my life, and although I believe I am a friendly caring person, and have good relationships with probably hundreds of people, I have not been able to make many close enduring friendships over the years. I am an observer.
Unlike many young people who often completed homework by the end of the journey, I could never bring myself to do that on the bus coming home. On occasion, I might have been reading an enthralling book, but as soon as someone got up to get off the bus, I would be distracted, look up to watch them manoeuvre, and my inner questions would begin. We might make eye contact, and I would smile, or nod, or answer a question; I was never shy. But it was not about making a relationship; it was about my questions.
From week to week, the same people would travel the same route, and I began to see change in them, or their relationships. Sometimes I might see a bandage or sticking plaster (bandaid), or note a lump or a bump. I can remember distinctly noticing a swelling in a middle aged and somewhat obese woman’s neck, and wondering why that had happened, and why she was a bit ‘dithery’ - slow and confused. In retrospect, this was my first awareness of a goitre, something that was to fascinate me about 10 years later during my medical training. I now know that I probably had a heightened unconscious awareness of the problem, given my mother had her goitre about a year earlier in my life. The details I was given about my mother were sparse, yet somehow they had prompted me to take note in another slightly older woman.
There was another strand in my life that began early. At about the age of 12, I had an ingrowing toenail which festered on despite baths and local treatment, and wearing sandals. I got taken to our general practitioner, a Dr. James Turtle, who lived in a big house with a surgery purpose built to one side. The driveway was circular and, parked in front of this mansion, was a large Jaguar car. You don’t know how impressed you are by such wealth, but I am sure I was. I was not overwhelmed though, and after Dr. James had had a look at my toe and its nail, he pronounced that it would only heal if the toenail was removed. My mother nodded; I don’t remember if she was anxious or not. So, Dr. James suggested I lie back in my school uniform and short trousers, while he went to work. I asked if I could watch, and with a slightly amused perturbed look he suggested I might faint. I denied this with confidence, not knowing what was to come. I watched in awe as he stuck local anaesthetic either side of the base of the toe (I now know this was a ‘ring block’), and we waited for it to take effect. When it was totally numb, he pushed a spatula down under the nail to the base, slid it from side to side and, deftly with a pair of forceps, removed my poor nail. I watched fascinated at the total lack of pain, and asked him where he had learned to do that? “At medical school;” he replied, “that’s where you get taught all the basics about becoming a doctor”. As I hobbled to our car, I said to my mother: “I am going to become a doctor”. I guess she would have smiled benignly, and I can’t remember either encouragement or denial. Was it the surgery, the fascinating knowledge, or the grand house and car? Whatever, the stage was set.
Within the next year of my thirteenth birthday, we gained a black and white television, a great square lump of furniture that sat grandly in the lounge at home. Every chance I got, I asked if it was OK to tune into medical programs. “Emergency Ward 10” (which ran from 1957-67), and was consumed twice a week.  “Dr. Kildare (from 1961-66)” in which his boss Dr. Leonard Gillespie told Kildare: "Our job is to keep people alive, not to tell them how to live", advice ignored through the series as they worked on physical and emotional problems. “Ben Casey” (from 1961-67) was another favourite about a young surgeon learning about neurosurgery. In have to say that I was lucky in that my mother was equally interested in the weekly diet, and it did not take much persuasion to switch on ‘the box’. Do these kinds of programs influence young minds? Or do you need to be fascinated by bodies and people in the first place? Or is the question of the chicken and egg academic variety?
More soon...

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