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Thursday, October 27, 2016

Making of a Child Psychiatrist: (55) Moving towards General Practice (4)

And so I learned about grief. The next few weeks were grindingly horrible for everyone. We each of us lived in our own puddle of sadness, trying to reach out to support each other, but struggling with what felt like a catastrophe.
I had to keep on with my work; after all I had only just begun a few weeks before. I wanted to walk away, but kept going having no idea about the accuracy of diagnoses, the quality of my work, and development of relationships; I just do not recall. I do know I had little energy or enthusiasm, and finished each consultation as soon as I decently could. Word had travelled fast, so there was the occasional condolence from people I barely knew. What do you say in return, but a bleak “Thank you”?
I was numb. But there were also times of extreme anger that an experienced GP did not actively follow up a smoker in her 50s with a chronic productive cough, who came from a family that included a history of cancer in the extended family. I swore to myself I would do better than that. At times I wondered whether I should report the GP, but I did not know how this was done, and just felt too empty of energy to follow through with what became just a repeated internalised threat. Was I angry with the staff at Ramsgate Hospital? How could I be when David and his whole team had tried such heroics? It was not their fault that it was too little too late.
When I was with family, I must have been very preoccupied. Even here I cannot remember much except the subdued tone of family discussions. So, I know there was a funeral, and have been reminded it was at St Saviour’s church where I had been a choirboy, where we had been married, where Jonathan had been christened, where Jan’s sister Wendy had married her Jim on the 24th April 1970, and where we planned to get Roderick christened. A ‘family church’… from which I wanted to run away. To my mind God had played a cruel trick piling life and family events on top of one another, perhaps to see whether we would survive. I have no idea who was at the funeral, but have been told that my Martin grandparents from Sydney were in the UK prior to going on a European holiday, perhaps even originally planned to include Eve and Ted. I assume they were there, as I assume family members from the May side also gathered. But I do not have a visual recollection; I guess I just wanted to close my eyes and run away. Then there was a journey to the crematorium. I do not remember driving there, nor do I remember what happened. I have always been the family photographer, but there are no photographs I know of from these gatherings. In fact, I became almost unable to plan taking photographs for well over a year. I was not aware of this at the time, but was brought to the realisation of it many years later when Rod asked us why there were so few photographs of his early years compared to those of his brother. He was not impressed, even when we explained.
Work was a distraction. I buried myself in the daily routine. Other distractions were attempted. I had formed a strong bond with Nigel, one of the male staff on the Obstetric Ward. As one of only two junior males in a women’s world we tried to back each other up when necessary. During work breaks or down time, we played cards in a common room, and I began to teach him bridge. After work, from time to time we sloped off to a local Casino that had only recently opened up in Ramsgate. Given my history as a medical student, I had ongoing ambivalent feelings about wanting to play poker. On the one hand, it was exciting and I thought I knew how to play. On the other hand, watching the games unfold it was all too rich for me and in the end I kept to my old Med School promise and never did sit down to play. I did play some blackjack and came out sort of equal. I did enjoy playing roulette and did some background reading on systems and odds. I had a couple of spectacular wins, but over time gave it all back. So I decided to not ever do that again as well. But the bright lights, the hubbub and the energy of the place did provide distraction. It did not fix the real problem, it did not make me a good family man, and Jan was to make that clear a couple of times. I gave up. Nigel was to become one of Rod’s Godfathers, although we lost touch very soon after I immersed myself fully in being the local doctor and settling down.
Even at that time, I formed the idea that distraction does not work. Working in the practice there would be moments when I forgot that I had just lost a precious person whose smiling acceptance, support and unfailing love had begun to shape the kind of person I was becoming. But then I would be driving to a home visit and have to pull over, turn the engine off, and just sit (and occasionally blubber). Or there would be a small reminder, a word or an image that would bring back a small flood of memories. And yet, Ted, Eve and Andrea had been in Australia for three years in my late teenage years and after the family got back I was engrossed in medicine and my relationship with Jan to the point that we rarely met up. No difference. In fact I may have been regretting those distances or absences. Like everyone else, you go over and over old images and tapes, searching for something you may have said or done wrong, something regretted. The phrase ‘if only’ can preface many of these micro-conversations with your self. I was grateful that I did not feel guilt about the last few months; I had recognised the problem as soon as I was informed and had done the best we could under the circumstances, even if it did not change the ending.
I know that others were grieving around me. Jan was struggling in her way, and I am sure I did not provide anywhere near enough support for either her internal struggle or her day-to-day management. As has happened too much throughout our marriage I withdrew into myself, and needed to work it out on my own. This is probably best described in modern terminology as ‘conservation-withdrawal’, not really a depression, rather a ‘reculer pour mieux sauter’ (a pulling back so you can jump better next time). But fancy terms don’t help maintain relationships, and I have been ever grateful that my soulmate in life has been prepared to suffer my vagaries.
Gradually, I found myself enjoying little bits of life again. A conversation over an extended family meal that included joyful old family stories might provoke laughter. Watching Jonathan struggling on the garden slide would provoke anxiety, care and an amusing story to be told. Watching Jan with Roderick developing the bonds that still exist today would provoke a rush of love and appreciation. My energy for life returned. Part of this was the need to find a home in Birchington. We came across a spectacular older style stucco house with lead lights and oak flooring and doors – an updated copy of a modernised copy of an Elizabethan design. It had high walls containing a simple garden, and gates apparently rescued reputedly from the old Bank of England in Threadneedle Street in London, with ornate dates (1826) in the design. The house was called ‘Old Gates’ and the address was Coleman’s Stairs – which made the whole thing very cutesy. We thought it beautiful, but the asking price was £14,000, somewhat more than our first home in London. The bank was once again very reticent to lend us money even though we had a deposit and guarantors, and I was in the process of becoming a local GP. Eventually an ultimately bad compromise was reached. The house was on the centre of three blocks, and the two outer blocks would be sold separately for houses to be built. The bank was prepared to lend the £9000 we needed for the house and middle block. So with a flurry of activity, and considerable help from extended family, we moved in.
There was so much to do and in spare time we buried ourselves in practical tasks. The small dining room needed a fresh look, and Dad came up from Bristol to share his wallpaper hanging skills to help turn it into a very smart little room. The kitchen was primitive and elderly, so I decided to clad the walls with pine boards and build a small and comfortable breakfast area with red padded seats complete with storage compartments underneath. In the summer I hired an extendable ladder and a backpack and cleaned up the stucco, spraying on a fresh coat of white paint. Later in the year as autumn emerged, I found some do-it-yourself double glazing that I put in place on the upstairs windows to take the pressure off an elderly boiler driving equally elderly large bore central heating throughout the ground floor.

We were settled, close to the practice and not far from the shopping centre, just up the road from a much loved aunt and uncle of Jan’s, a short drive from Jan’s parents, enjoying our growing family, and in our own home. Given all the changes leading to a more settled existence and the passage of time, we healed.

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