Tuesday, October 4, 2016
Making of a Child Psychiatrist: (47) Working in Medicine (3)
I am acutely aware of the ironies in this next anecdote. I was on call, and in the middle of an emergency when Jan managed to get hold of me to say her waters had burst, and she had started her labour. The problem with medicine is that you cannot casually drop a procedure when you are in the middle of it in the way you might drop paperwork on a desk, or hand over to the other waiter in a restaurant. I was going to be at least another half an hour, and could hear that Jan needed action and needed me there as support crew as soon as possible. She needed transport to Dulwich Hospital where she was booked to give birth, and the bizarre best I could do was to call an ambulance. As with so much of our lives, from time to time medicine has come first, and our commitment to each other second. I have often had cause to regret that. I finished up at King’s, raced down the road to get the Mini, and drove to Dulwich, parking in the doctors’ car park (as you do).
Following the signs I found the ward, and the right room, and announced my presence much to Jan’s relief despite the fact she was focused internally, and the smile was half a grimace. It was to be several hours of holding hands from then before events really got going. Although our dear baby was head down and in a good position, Jan is tiny and he was rather large and fighting to find passage room to be able to join us. An older colleague with whom I had played rugby was the junior registrar John Sutton-Coulson, and he and the nurses were convinced that forceps would be necessary ensure a live birth. I was not happy, given the use of even the smaller Wrigley’s forceps can cause trauma to both child and mother, and on the basis of my intensive month of Obstetrics in Plymouth, still fresh in my mind, I argued as strongly as I could. John took me outside; he was patient but firm, explained that our new baby was a ‘face presentation’ (ie back to front), the odds of a natural birth were slowly waning, and rather forcibly persuaded me to agree. “If you want a live baby, and don’t want Jan to suffer too long…” I went back in, replaced my mask and tried as much as possible to support Jan. My poor little lady wife…
But then it was over, and there was our Valentine’s Day gift, rather large with a shock of dark hair nestling comfortably into Jan’s breast, while John completed some repairs. I was overwhelmingly grateful, and Jan was relieved. We wept, of course; just like the ordinary people that we are.
There were strict rules around childbirth and the puerperium in those days. A 10-day stay in hospital was the rule. So Jan and Jonathan had to stay. Jan had wanted to breast feed, but the daily ward routines and nursing staff with rather strict ideas about feeding to time rather than on demand seemed to get in the way. Jan struggled to do her best, but we were destined to end up bottle-feeding. Visiting hours were part of the strict routine, and later we laughed every time the story was told about how all mothers had to be clean and tidy, hair neatly combed, and propped up in bed; all babies had to be in the cot next to the bed unless they were too distressed, in which case they were moved to the nursery. All beds had to be neat and tidy, with the wheels all turned inward so as to not have visitors trip over them. There was a tour of inspection by the ward sister before visitors were let in.
Once back home in our rather austere high ceilinged ground floor hospital flat, for the next couple of months we had to turn up the heat to protect our little one. We ended up moving almost entirely into the kitchen dining area, ignoring the other two rooms given they were so hard and expensive to heat. We plotted the move to the new house, planned basic furniture we would need, and as Jan regained health we gradually bought necessary bits and pieces we would need to furnish a home for the three of us.
I must admit I really don’t remember much about the changeover to my new job, or what happened through that summer of 1968. I don’t remember the consultants or registrars, and few of the patients stand out in my mind. My head and my heart were obviously somewhere else. I say that advisedly because it marked a permanent shift in me. The possibility, however remote, of losing our unborn son and the possibility of serious damage to Jan made me realise that my new family should always come first. It was an emotional rather than a totally conscious shift at the time. There would be times down the track where work would once again take me over, and then there would be some sharp reminder that the only thing that matters in life is the closeness of a loving family. That forms the base on which you can do great things with the skills you have, and can carry you successfully through any trauma. At work you can become dispensable; at home you are always indispensable. What I have only begun to understand, using my retrospectoscope, is that these ideas about family life, ‘principles for living’ if you will, would end up guiding my search for knowledge in psychiatry, and my clinical practice.
I do remember that the six months was a very mixed job, half pathology and half diabetes and endocrine; it was at times frenetic. Days were divided into ward rounds and clinics, but also there was a steep learning curve around rapidly developing techniques in pathology, especially biochemistry. When on call, I would have to complete tests that were not yet on the autoanalyzer. The main one was measurement of blood sugars. This had been possible since early work in the 1920s and, although improvements had occurred, it demanded caution. The technique involved separating the serum from the blood cells, and then adding chemicals to a small amount of serum to create a blue colour that could be compared with a colour chart; all very straight forward. I was told not to inhale or imbibe the chemicals because they could increase the chances of cancer; not so nice. I have to say I much prefer the Glucostix method created in 1986.
There is a sense of regret that I may not have given all of my mind to the Endocrine part of my clinical job, and at the time was not aware of the history of the Diabetes Clinic, created by RD Lawrence who was a legend at King’s. He completed undergraduate training at King’s College Hospital, and having developed diabetes in 1920, became one of the first to use insulin in 1923. He was a champion for the care of diabetic patients, set up the Diabetic Clinic at King’s and was the founder of the British Diabetic Association. Sadly I never met him, and I understand he died in August of 1968.
One bonus was that if I needed to get some background around pathology techniques, or autoanalyzer results, I could always ask Jan. By the time I began this my third job, Jonathan had reached three months old, and Jan had begun part time work back in biochemistry. So from time to time our paths crossed even if never as much as I might have wanted. She managed well seemingly able most of the time to induce sleep in Jonathan so he would be snuggled up in the pram with Jan checking on him from time to time and spending lunch breaks with him. At other times, there were some wonderful cleaning ladies in the department quite happy to keep their ear out for the beginnings of wakefulness; always up for a cuddle. Again, in retrospect, I am amazed at the tolerance and acceptance of the workplace, but it was also a sign of the esteem in which Jan and her capabilities were held. They wanted her; she wanted to be there; they continued her employment. Times are so different today, and there would be a thousand and one workplace health and safety rules that would block such an arrangement.