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Tuesday, March 7, 2017

Making of a Child Psychiatrist: (60) The General Practitioner (5)

Work in the practice was always busy. In winter, the local residents would get winter chills, or slip on ice. But in summer, of course, there was an influx of visitors to our tiny seaside town, and so surgery was swelled by people from all over the country, seeking sunshine in the south (such as it is in an English summer). Occasionally the days were very long.
There were odd legacies from Dr. Bowie’s time, and two of them filled me with delight and were never perceived as burdensome. I have already mentioned the Dr. Barnardo’s home. This was a group of two storey rather utilitarian brick buildings set in a park like environment with concrete pathways and flower beds, about half a mile out of Birchington. Each building housed a family that included two ‘house parents’, usually a married couple, and up to eight children who were part of that family. At it’s simplest, my job would be vaccinations, or a small outbreak of german measles that travelled from family to family. Occasionally there were more serious problems, but now I look back with the experience of my training, I do not remember much in the way of behavioural problems, or school refusal, or the result of jealousy or fights.
With my retrospectoscope, and my experiences deriving from working in the mid 1970s onward at a children’s hospital psychiatry department, and my relationship with the Association for the Welfare of Children in Hospital and experience of children in brief separation, I now marvel at how well Dr. Barnardo’s ran, and particularly how well the surrogate parenting process worked! Where were the troubled children suffering the loss of their natural parents? I am sure I have not forgotten examples of children reacting to prior trauma.
The ‘family’ size seemed to have been optimized. Parents were knowledgeable, caring and kind. I understand they did not have that much formal training, but they just seemed to be ‘good’ parents, and the children seemed to have love and respect not only for their foster parents, but the whole foster family. It was often noisy while I was there, but never in an angry way. I am sure there were support staff for the system, but they were never mentioned, or brought into the equation to discuss what were predominantly physical problems. It seemed to my then untrained eye that the system just worked well.
The other system that seemed to work well was a small preparatory school called Grenham House, for about 80 boys aged 7-11 who would later move on to more illustrious senior boarding schools. Again, Dr. Bowie had looked after the needs of the school for many years, and although there were some early concerns at my youth and inexperience, I came to be accepted. The owners of the school were Denys Jeston the principal, and his wife Eve who acted as a 'House Mother' and part-time Matron. In addition, there were two nurses and a range of teachers for the various years. Although most of the boys were boarders, there were some local day boys. The school curriculum included the usual Maths, Science, English, French, Latin, Geography and History, Art and Music, and it had spacious grounds with room for cricket and rugby pitches, there was a swimming pool, and I understand there was an option of learning Judo.
My knowledge of the functioning as a school was limited; in a sense that bit was not my business. There are always preconceptions about boarding schools, and of course from time to time there have been horror stories. There have been some retrospective online personal stories of school life hinting at brutality (eg caning) and even possible sexual abuse at Grenham. I never came across any young people suffering such indignities. Maybe such events were kept from the local doctor, or perhaps my own awareness of the possibilities of such events was at that stage towards the naïve end of things.
My job could be very busy at the start of the school year, when a new influx of small people joined the school. The arrangement was that they would all have a brief medical history written down by prior doctors, and that I would do a brief physical examination, and write up any findings. Given Denys’s military background, these days were run in an efficient and orderly manner, with the school nurses working alongside. Subsequently I might be called in from time to time to deal with an acute illness, or see someone in the sick bay, or to prescribe ongoing medication when the home doctor had not provided enough, or parents had not provided enough. Although my role was seen as being there for physical ailments, I did get to see some very young boys who, in the early days, seemed miserable at their separation from parents, but these issues were solved quickly and reasonably enough as far as I could see.
Hidden away in the occasionally stately houses of our small village there were people whose stories were extraordinary; I guess this is always true of small communities. You may meet what look like very ordinary folk in the local shops and greet them politely, yet never be privy to their stories. But as a local doctor, particularly on home visits you do get to learn something of the richness of their lives, even when you are obliged to treat them as ordinary bodies.
One of these was a patient of John’s who lived at Quex Park. He was added to my home visit list one day when John Hayden was on annual leave, and I asked one of the nurses for directions. She obliged, but gave me an odd look as if I should have heard of Quex Park. Christopher Powell-Cotton had taken over the management of Quex House in 1964 after his mother died, and now lived in what was to become a very famous stately home with its own vast natural history museum full of specimens from around the world (including a full sized stuffed elephant, I later learned).  I was told I would find him in the conservatory, and having been guided through the halls of an elegant and enormous country home, I entered a vast enclosed light filled and uncomfortable warm space full of botanical treasures. Christopher was an imposing, quietly spoken man in his early 40s, with a military bearing. He was examining some orchids when I arrived, and explained that they came from Nepal and needed very special care in our English climate – especially during winter. He hoped that I did not mind coming to the house, but he had been suffering a chesty winter cough that he could just not shake off, and had wondered whether he needed an antibiotic or some other treatment. He told me that he was only weeks away from an annual expedition to Nepal in search of new varieties of orchid to bring back to the UK. And could I possibly check his blood pressure and listen to his heart to ensure he was fit for travel? He explained that the atmosphere in Nepal (being in the Himalayas) was somewhat rarefied, and contained less oxygen than elsewhere and he was anxious to be 100% fit. He could not afford to be ill on his trek. He took me back through the house to a study, and I did the necessary. Clinically he had suffered a bout of influenza, and now had mild bronchitis. His heart and blood pressure were normal, and there were no more symptoms to suggest anything to worry about. I was sure he would recover with the prescriptions I gave him, but would ask Dr. Hayden to see him in a few days to check on progress.

When summer came round we joined the throng of people visiting Quex Park for the annual Quexpo. There were sheep dog trials, and roundabouts and sideshows. The boys were intrigued by the old steam engine races – all revitalised and repainted with an ancient pride.

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