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Saturday, May 6, 2017

Making of a Child Psychiatrist: (73) The General Practitioner (18); Characters

Amongst my many treasures, I have an etching by a Nicholas van Haeften (1663-1715). It is called ‘The Physician’ and dated 1697 and copies exist in several museums including the Rijksmuseum in Holland. It is incredibly evocative of the patient weariness of those waiting to be seen, and the gauntness of the physician struggling to assist. It was a gift from a nurse who ran an Old Peoples’ home in Birchington to which I was called in every week or so to check on residents or renew medications. I had quite enjoyed the visits over time, getting to know many of the residents even though some were a little moribund. The matron seemed very competent and caring, and I never had occasion to doubt the quality of her care and sincerity. Just as one marker of care, in all my time I never saw a case of bedsores. The home also had the support of our own district nurses, and I know they had always been impressed. The occasional chesty cough during the winter months, and the occasional story of aches and pains were all I had to listen to. There were no serious falls to attend to, no terminal choking fits. So the job was easy really. All finished off with a biscuit and a cup of tea, of course.
Jill was in her 50s, and never really spoke of any family life except a reverence for her father who had been a long-term surgeon in the navy and had toured much of the Far East. Clearly he and his career were revered, and I was always happy to listen to stories of his exploits. From time to time I would share recent bits of family life and exploits of our two sons, or tell her of the latest exploits of Margate Round Table or my contact with the Freemasons. Jill’s father, of course, had been a freemason.
When Jill found out I was playing with the idea of leaving Birchington after 4 years and possibly taking up a career in psychiatry, she was upset and it took a lot of work to assure her that, if it happened, I would make it my business to hand over carefully to my successor and make sure they were primed. The van Haeften was a parting gift, along with a small exquisite watercolour painting by a Japanese artist Ginnosuke Tasuke Yokouchi (1870-1942). Both had been treasures belonging to her father, and she said she knew that he would want me to ‘take them on my travels’ as a constant reminder of his dedication to his patients. Ultimately, the Yokouchi led to a passion for Japanese watercolours by GT. They are ethereal, and evocative. I now own nine of them (purchased over the years from the Internet), and wake every morning to look at three of them that evoke the head of a river, a bend in the same river much lower down, and a harbour full of boats which emerge from the background the longer you look. All three have areas of the same reddish colouring which seems to link them together. I have no idea whether they were painted as a series, but that is how they impact on me. Exquisite otherworldly beauty to start the day, for which I thank Jill and her father. I hope I have done his memory proud even if our two careers were separated by a generation and poles apart in scope.
There is an issue in here for doctors; that of accepting gifts. Perhaps as a GP it is acceptable to simply smile and say 'thank you' given there are few implications with regard to preferential treatment. And I always felt that it could be very rude not to acknowledge that people were genuinely thankful for the care you had provided, even if it was your job. I was later to learn that for a psychiatrist it can take on other implications, and the generally accepted wisdom is that it may skew your therapy in providing some obligation to your patient which may halt you saying something adverse (but therapeutic) at an appropriate time. It's complicated.
Another character to mention is Len Head who had developed a business in wood, partitions and the building trade. He lived at Whitstable but for some reason had become attached to our practice. Initially he was with one of the senior partners, but came to see me a couple of times and seemed to like my style. He had recurrent asthma, and with changes in the seasons would need additions to his regular medications. In addition, he used oxygen. He had developed a theory that when the barometric pressure was high, asthmatics found it harder to get enough oxygen. The solution was to have a small cylinder at home and use it if conditions deteriorated. I had never heard such a story, and the way Len told it sounded slightly eccentric (shall we say). But I organised his prescription, and from time to time he would be back for another session. These were always hilarious; he had a fund of genuinely funny jokes, and lots of other eccentric ideas that largely amounted to him telling this young doctor how to be good at his job. I took it all in good part, and bit by bit we became friends. At some stage, we found ourselves talking about playing bridge. Apparently both Len and his wife enjoyed the game but could not find enough partners; would Jan and I like to play one evening? I checked it out with Jan, and she was reluctant given her bridge experience was a bit limited. Her family had played a wide range of card games over the years, but bridge was never part of that. Of course, given my medical school card-playing experiences, I had taught her the rudiments on evenings at home, and we had played social bridge from time to time with friends. I thought that might be enough, and eventually she agreed.
Len said that finding his place in Whitstable was bit a bit complicated, and the best solution would be for him to pick us up and go to their place for dinner and bridge and then they would drop us home. All a bit odd, but we acquiesced. On the appointed evening, the baby sitter arrived shortly before a Rolls Royce slid into Coleman’s Stairs and pulled up outside Old Gates. I am glad it was Len driving, given the squeeze, and the nearness of our rough hewn flint walls. We were both a bit bowled over, and inwardly I shuddered at the possibility of scraping a door as we climbed in. We had not met Len’s wife, and the opening conversation in this rolling barn of a space was a bit stilted. The house was a mansion, the dinner was a superb set of creations, conversation eventually glittered as a couple of expensive wines oiled the interaction. The bridge was quite ordinary, given Len’s wife was somewhat new to the game, but we all had a good time – and they won (always a good result on first meetings). And a month later, the Roller returned to be parked at our place while we hosted them.
At about the same time in our lives, I had been approached by Mensa to see whether I would be able to be a local secretary for East Kent? That all sounds very grand, but I was assured it would not take up too much time, but might involve holding an occasional social gathering at home to welcome new members. I suppose I was flattered. I probably should not have been, but when momentous shifts are emerging in your life, and when you are uncertain about what direction to take, it takes a toll and times of anxiety and loss of self-confidence can occur.
It was that scenario that had led to my joining Mensa in the first place. I had been struggling for some months in the lead up to finals in medicine, and was convinced I was going to fail. In retrospect I think my moods must have been partly driven by the fact that both Jan and I had shared Glandular Fever over a six week period, much of it spent sleeping. I did not recognise my depression as such, but just dragged on day by day. I was walking down a street one day and came across a sign on the pathway advertising Mensa and its test. I was intrigued, and thought it might be a good idea. If I passed (which I doubted), then that might give me confidence to do my finals. If I failed then I would give the whole thing up and ‘go and get a proper job’. I argued with myself, but eventually did the test. When the result came, welcoming me to Mensa as a member, I though it was an error, and phoned the offices to double check. There was no error. So it acted as a turning point. I renewed my study efforts (having probably now somewhat recovered from our shared illness), and the rest is history.

Anyway, I accepted the challenge and became the East Kent LocSec. Enthusiastic to get going I wrote a letter of invitation to all the members on the local list supplied, and offered an afternoon tea at Old Gates. About 10 people turned up and over the next two hours, an awkward and very stilted conversation got going. We came from a wide variety of backgrounds and occupations, and these days I would probably label the vast majority of the members as ‘introverts’. There seemed to be little common ground, except that everyone had a large number attached to their membership. It was a non-starter, in many ways a disaster, and one of the most boring afternoons that Jan and I had ever had. Apparently (as I am sure is evident to everyone else) a high IQ does not guarantee a social personality or a sense of humour. Perhaps they too had all joined when they were depressed, just to prove something to themselves. We were to hold a second event some months later to welcome two new members, and to prove that the first occasion was ‘just one of those days’. It wasn’t, and we never tried again. It has always seemed like a missed opportunity; supposing all those minds had found some common socially minded purpose? What could we have achieved? I never did find out.

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