While Ken Munro Fraser was senior in experience, I was
to find out he was flexible and open to new ideas. He allowed discussion, and I
decided to keep quiet and listen. I had done enough damage with my ‘foot in
mouth disease’. Or perhaps not! Over the next few weeks there followed a
general airing of ideas about assessment and choosing appropriate therapies for
any given child and family. Ultimately, even though I was only there once a
week to join in the subsequent clinic discussion, I found out there was a
decision about a changed process, with cases allocated within limits on a
roster to any of the professionals. The idea was that the ‘case manager’ would
gain the best understanding of the case that they could, and then bring that to
a team meeting where the next steps in the assessment could be organised, and
appropriate therapy planned. It sped the assessment process up, and took
pressure off the social workers who often had to ‘hold’ a case until a
psychiatrist or psychologist was free to complete their assessment. Of course
Ken retained overall control over the decisions, given he was the Director and
therefore would have to face the music if anything went wrong.
The reports I heard were that the process was quicker,
with professionals able to begin some intervention during or after a first or
second interview session, without having to wait for the main team meeting, so
patient families felt they were getting some ideas and strategies almost from
the beginning. Of course additions or changes could be made if the meeting
consensus suggested something. From a personal perspective, it meant I could
see cases for whom I had some ‘ownership’ and responsibility for diagnosis,
process of assessment, therapy and reporting back to the team meetings. Luckily
I was having some supervision each week from Ken to ensure I was looking at my
own reactions to families and children, but also learning new skills. He was
always suggesting some reading to help this, and would sometimes provide me
with an article copied his secretary. So my one session a week, would often
entail me spending another couple of hours a week in the evenings. Far from
onerous, I found the process exhilarating.
Not that my work in the practice had lost any of its
lustre, and there always seemed to be something new happening. We had a social
work student approach John Hayden to seek a placement in the practice. Her
expectations were that she might get to sit in on clinics, but also spend time
around the practice with midwives, our district nurse, and even my visits to
St. Nicholas at Wade. She was pleasant, enthusiastic, and careful not to
intrude if patients were unhappy for her to be present. Jean had an assignment
to complete prior to finishing, and we discussed ideas in the tearoom and while
driving.
Two of my clinic patients at St. Nicholas were middle
aged men who had each spent many years working as miners at Chislet (until it
closed down in 1969) and then Betteshanger coal mines. Jean thought it would be
a really interesting experience to go down a mine, facing some of the trials
that miners put up with every day. These days, I suspect, all sorts of
bureaucratic blocks focused on occupational health and safety might have been placed
in our path. But when Jean approached her mentor to gain permission to shape
part of her general practice report around the experience of miners, she
thought it was a creative idea. When Jean approached the hierarchy at
Betteshanger, they welcomed the idea of having real life health professionals
gaining experience of working conditions.
And so, with only minimal discussion at home and in
the practice, foregoing my three piece suit for some older somewhat daggy
clothing one Wednesday afternoon I found myself descending into the depths in a
wooden cage dressed in miner’s dungarees, borrowed boots, a helmet and a
slightly flimsy facemask. Jean was very excited and kept the miners talking
about their experiences. I was less enthusiastic, if not increasingly anxious.
I am not sure what I had expected; perhaps a mini-presentation from a miner or
supervisor, a visit to the wooden cage, and then a tour of the onsite museum
followed by a cup of tea. No such luck!
I realised they were actually going to take us down
the 1600 feet or so in the cage (which was noisy and appeared rickety to my
untutored eye). I felt unable to say no. I was not being gallant for Jean’s
sake; she was thrilled by the whole event and did not need that a mere male to
support her. I just felt a bit embarrassed to wimp out, so I gritted my teeth
and smiled while Jean went enthusiastically through her lengthy list of
questions about mining.
After a shaky, rattling descent that felt longer than
it actually was, we landed and the cage door was opened to the dim lighting of
a cavern. We were met by the driver of a primitive underground electric train with
open seating on narrow gauge rails. I have no idea how far we travelled, but
the rounded ceiling seemed to get lower, and the walls closed in. Jean kept up
her tirade of excited questions. How did the air stay fresh so far down? (Everything
had begun to taste of coal of course, despite the facemasks). Were they still
using the pit ponies about which she had heard? Not any more. Had there been
any serious accidents? Not for many years. At the end of the line, we were told
that to view the coal face we would have to crawl along a passage under what
looked like wooden trestles maybe four feet high. Jean had already accepted the
challenge and I had little choice but to follow. Lights were strung on the
trestles, but the view either side was limited. The track was not really wide
enough to turn around even if I had no-one behind me; the forty yards of
crawling felt like an eternity. We arrived at a more open area and could see
the open face, with miners drilling holes into rock. I tightened my facemask,
and wished I had earplugs. The holes would eventually hold an explosive charge,
the idea being that the whole face of coal would crumble down ready for transit.
There was what felt like interminable discussion of the intricacies of
explosive charges. These were men who knew what they were doing, given their
lives depended on not making mistakes. There was pride in what they did, and
trust and strong bonding between them. You smiled, and asked rather obvious
questions; the miners smiled back and give rather obvious answers. I was struck
by their acceptance of this dark reality of their work lives, and the tolerance
for extreme working conditions. In contrast I felt a hint of shame in my own rapidly
building need to return to the surface. I wasn’t sure I could get out quick
enough to maintain the shreds of my dignity, and the return journey seemed
endless.
I suspect there was endless discussion and a series of stories and
jokes between mates in the pub about these two odd professionals needing to explore
their work lives. Later I was to meet the two miners who lived in St. Nicholas,
and was pleased that they (being blokes) were happy to come to the doctor to
discuss often quite intimate problems. Separately, they both asked (with
twinkling eyes) if I had enjoyed my visit to the mine, and whether I had
recovered from being at the coalface. Obviously the story had got around.
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