Monday, October 17, 2016
Making of a Child Psychiatrist: (51) Training in Psychiatry (4)
There were certain advantages to being a senior house officer rather than a registrar in psychiatry. I was not deemed to be experienced enough to be on call, so essentially the job was 9am to 5pm, even if I had to do the occasional weekend. As you would now have guessed, the work was intense and somewhat wearing. Not only was I learning how to manage a wide range of fairly serious disorders but there was also an expectation of doing a fair amount of introspection. I have never shied away from that, and understood from early on the importance of it in relationships with people who were struggling. The phrase ‘Primum non Nocere’ (first do no harm) took on a very special meaning.
I was also on a very steep learning curve at home. As I have noted before, we had moved into our first true home in about April 1968, with Jonathan born in the February. By the time I took up the psychiatry job in October, he was getting on for nine months, and able to sit and begin to take in the world. He provided endless fascination and nappies. Jan seemed to have taken on the tasks of parenting so naturally, but I was a learner and paediatric training in medicine does not provide you with much in the way of skills to be a parent. We had both had siblings about 7 years younger. Jan had always been fascinated by her little sister and her development, and took an active part in helping whenever she could. In contrast, as a boy, I had very little interest in my baby sister; she was just a noisy nuisance taking up all my mother’s attention, and doing that embarrassing breast-feeding thing. I was happy to be roaming around with my friends outside the house.
So, I know I was not a very competent parent to begin with; rather, I was a rank beginner on a steep learning curve. Jonathan was not easy to settle down at night, so we often had to stay awake till late, or get up repeatedly. Even so he was a joy and, like every set of new parents, we were fascinated with each tiny developmental advance, overjoyed by each smile. I guess I was also taking a professional view of his development. Was he on track? Was he normal (whatever that means)? Who would want a doctor and proto-psychiatrist for a parent?
There was also a lot to be done in our new home home. While the outside of the house had been renovated and appeared modern by comparison with the rest of the street, we wanted to decorate the inside to our taste. Like all new homeowners, we wanted to make it ours. So we painted walls and ceilings, organised carpets, and built simple bits of furniture.
Jonathan was getting too old to go into work with Jan, so we had a compromise to make, and were both unhappy about it. Jan found a day care situation with a woman she quite liked, where Jonathan was duly parked each day at the block of flats to allow Jan to go into work. She was very torn, but got into a rhythm of dropping him off each morning with his pram for morning naps, then walking the remainder of the 2 miles on to King’s for her half time job. She was relieved when she returned each lunchtime to find him still in one piece.
There were also, of course, times of great anxiety. One evening when Jonathan was about fourteen months old, he developed a fever and was literally ‘burning up’ with a temperature in excess of 100 degrees Fahrenheit. We tried cooling him down, gave him some infant aspirin, but it went on and on. My paediatric skills were not helpful when I was so personally involved. Late that night we decided we had no choice but to take him down to King’s Casualty. We got clerked in, and watched in horror as our little bloke was stripped down to nothing, and sat disconsolate on a cold metal trolley inside our screened cubicle, while nurses wiped him down with cold wet flannels. Jan was desperate because we would have done nothing like that at home and it seemed so brutal. I was outraged because I feared he might develop pneumonia, if that was not already the problem. We were turned from professionals into scared parents, and felt that sense of helplessness that everyone must feel when you become a number, just another case. He was seen by a paediatric registrar and had an Xray of his chest. All good apparently! Eventually his temperature did come down, he was given a dose of penicillin, discharged, and we dressed him and took him home – not all that impressed, and vowing to never repeat the experience.
The house was very close to Peckham Rye Common, so when weather allowed we would go down to the park and enjoy being a family. We have photos of sunny days, and all of us smiling, as well as one glorious one of Jonathan in a pushchair with his curly hair, pudgy baby face covered in ice cream. We were just an ordinary family out having fun; just as it should be.
My year in psychiatry was coming to an end. It did not matter how well I had done, how many apparent successes we could count, how much I had enjoyed the experience, or how much I was liked; there was no immediate prospect of a registrar position at King’s. I looked elsewhere, but just could not find a job in the medical journals; all very depressing. For the last six months I had become increasingly anxious about what to do next. I discussed my career with consultants and registrars but no leads began to appear, and our little family needed financial security. I know I became increasingly morose, and not much fun to live with.
And fate stepped in. Jan’s father had from time to time played golf with a couple of general practitioners in Kent, and had discussed our situation. Apparently an elderly GP Dr. Alan Bowie, who had completed 35 years of medical service in Birchington (the town of our old drama group, and early courting days), was about to retire. His junior partner, Dr. John Hayden, was now looking for another doctor. Jan and I spent days discussing the option. It meant moving on from psychiatry, and moving house again; but what could be nicer than a beachside and rural practice, only 2 miles from the town where we had both grown up? What could be nicer than moving close to family? What could be nicer than almost trebling my current salary?
I met up with John Hayden for a discussion one weekend, and we got on well. The job sounded manageable. In addition to John, there was one other long-term doctor (Dr. Denis Merritt). The practice overall had just over 10,000 patients, but with some new council estates being built, the numbers were growing. My flock would be about 3,000 people in Birchington and perhaps some in Westgate, as well as the surrounding farming communities of Thanet including St. Nicholas at Wade, Sarre and Pluck’s Gutter in one direction, Acol and Minster in another. I would be expected to look after a Dr. Barnardo’s home with about 100 children, and be on call for the whole practice one week in every three. I had no concept of what that might entail, but John assured me it was not overly taxing, and I would not take long to grasp the whole thing.John suggested I would be well advised to complete 6 months of Obstetrics training before beginning, given the number of births each year in the practice and surrounding villages (about 200 a year). Given my joy in my student midwifery training, that sounded good. John had heard there might well be a senior house officer job coming up at Margate Hospital (where I had worked very briefly as a nurse assistant 10 years before); he said he would find out more. I put together a brief curriculum vitae, and wrote to the Director of Obstetrics at Margate Hospital, discussing the plan to move into General Practice, and noting I would like to work towards a Diploma in Obstetrics. The response was rapid and positive, so I guess there had been few other applicants (if any) for this small hospital outpost on the tip of Kent. There was a bonus. A ground floor hospital flat in a small block almost next to maternity would become free shortly after I began work. Would we be interested in moving into that? How fortunate could we be?