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Thursday, April 13, 2017

Making of a Child Psychiatrist: (70) The General Practitioner (15); A bit more Child Psychiatry +

In supervision Ken opened up the idea of whether I should consider child psychiatry as a career. There was no pressure; just a collegiate discussion. He was aware I had only done one year of fulltime psychiatry, and therefore could not take the exams for the newly chartered Royal College of Psychiatrists, the former Royal Medico-Psychological Association (for which I was already an associate). That would take a further year of full time work in psychiatry to meet the basic requirement. But he thought it might be worthwhile taking the Diploma in Psychological Medicine examination for the Royal College of Physicians, which only required one year of full time work (already completed at King’s). He saw it as useful for the future if I ever decided to change career direction. I assured him I was happy in General Practice (which I was).
But some weeks later he asked if I might be interested in going up to London with him to a weekend of updates in clinical child psychiatry. Technically it was for consultants, but he was certain it would be fine for me to attend. I think he thought I might be company on the drive up and back, but now know he was being somewhat devious (bless him).  I was intrigued and excited, if a bit nervous. Once again I was conflicted, taking time away from the family to follow my personal interests. But Jan was excited for me, and fully supportive (as always), encouraging me to go. I had no details, and had no idea what to expect.
The meeting was at the Maudsley, just across the road from King’s. It was a surprisingly small group of people, with 15 of us packed into a seminar room. In my naïve state, I was taken round and introduced to all these people whose names meant little to me at the time – including Michael Rutter, Christopher Dare and Bill Yule, as well as Philip Graham (I believe). All four presented recent research and provoked lively discussion about the implications. I had never heard of the Isle of Wight studies, but they were to become highly influential over the years, as was so much other work done by Michael Rutter. Bill Yule talked about the use of various forms of behaviour therapy with children, and I found this refreshing and clear. I really liked the man and his approach, and (even though I was no longer in the UK by that time), I was suitably impressed many years later when it was he in charge of the psychological work after the cross channel ferry disaster. Chris Dare was also impressive, even though at that stage he was a registrar (I believe); enthusiastic and engaging he talked about some approaches to working with families, perhaps presaging his later seminal work with family therapy and young people with Anorexia.
What intrigued me as much as anything was the free and inclusive discussion after papers, and clearly these soon to be eminent professionals welcomed feedback, even from a total unknown. It was heady and, with the benefit of hindsight, it clearly turned my head.
I ended up determined to follow Ken’s suggestion of completing my DPM. So I set about investigating processes, dates and possible content and put in the application. In the meantime I found a brief 2 day registrar workshop on General Psychiatry, which aimed to be a final tune up for College exams. It was a great weekend covering a wide range of topics, even if I was totally out of my depth. There was a multiple choice exam at the end of the weekend - which was totally novel! I had never come across such a thing. In addition to having to face this, rather weirdly the scoring system did not just give marks for correct responses, but took off marks for incorrect answers. I scored some idiotic number like 9 out of a possible 114! Perhaps I should have taken this as one of several omens that perhaps my future career would not be as plain sailing as it might have been. But what I did was to take every available minute to study across the whole age range of psychiatry, and build up to the exam later that year.
I caught the train into London and went back to Queen’s Square to take the papers. Nowhere near as anxious as for my various final exams in medicine, I came out feeling I had done fairly well. Luckily there was no multiple choice…
An odd thing happened on my way home. I had bought a cheap day return ticket and arrived too late; the rush hour had just begun, and on that ticket I would not have been allowed to travel until about 7pm (without paying a premium). I was listening to the news in a café and heard the breaking news of two bombs that had gone off near railway stations in London. I was worn out by the travel and the exams, and did not need the anxiety of sitting around waiting for the IRA to practice killing people. From a public phone box I phoned Jan to tell her the story. Despite our slightly struggling finances she agreed it would be best to pay the excess and catch the next available train – which I did. It's a funny old world.
I later I completed the clinical and viva. The DPM would not get me consultant status anywhere, which was good because I had far too little experience as yet. But it was a sign that I was committed to trying to understand mental health and illness; and maybe that I was on a pathway out of general practice.

A very odd thing happened about two months later. I received a package through the post. The postman was unsure what it had in it, and there was a note in out letterbox to say he had left it on our concrete coal bin. It was padded, but within you could feel various shapes both hard and soft that made no sense. There were what appeared to be wires. I was slightly freaked, in part because of my crazy Victoria station experience. I called our local police, apologising for being a nuisance. A panda car came round to the house with two grinning officers. Both felt the package, and not very convincingly said they thought it was nothing serious. We scattered up the drive while one of them got out a penknife and, holding the package at arms length, carefully slit down one edge. Gingerly he pulled out the weirdest collection of ‘stuff’; a bottle top, half a torn playing card, bits of unfinished poetry in a hand I did not recognise, a used match and odd bits of disconnected wire. There was a tiny noose made out of cotton. There was nothing coherent. The police left, having smilingly patted me on the back; joking between themselves about the story they had to tell. I was embarrassed, relieved, curious and perplexed. My best bet, maybe surmised from a couple of bits of the handwriting, was that Jenni had sent me a message. What it meant, I could not work out; perhaps a mix of old anger and jettisoned bits of a despairing past. Unfortunately we were never to meet again; follow up in those days was a bit limited given the small numbers of child psychiatry professionals. Some years later I did find out, in a roundabout way, that Jenni had completed her nursing training, and had moved on to midwifery. I hope she had a good life.

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