Growing Into Medicine (24 page)

‘Would you like me to lift her?’ I asked.

They nodded. I put the bundle into her outstretched arms, moved almost to tears by their tentative joy.

After nearly four years working in London, Ralph was posted to Leyhill open prison in Gloucestershire. The previous governor had not lived in the designated house, which was now occupied by another member of staff. Ralph suggested we could live in Bath and he would commute. The Home Office agreed.

I was delighted to move into our retirement house four years earlier than expected. A succession of student tenants had neglected the garden. Ground elder ruled the flower beds and despite my efforts over the next thirty years, the leaves still push up through the soil with depressing frequency, reminding me of the roots below that are as impossible to eradicate as the child lurking within every adult.

The medical establishment in Bath was not easy to breach. The wives of many of the consultants were medically qualified and had snapped up the available part-time work. I was forced to travel to Bristol and into Somerset for sessions in family planning, although it was not long before I was appointed to a new psychosexual clinic in Bath. After a while, in addition to this work, I helped out in the general practice in Radstock, eight miles away. The town had been
the centre of an area of open-cast mining and the small remains of the stalwart mining community were very different from the Surrey population I had recently left. Within the first two weeks I was reminded of the patients in Pontefract, the Yorkshire town where I had first become a doctor.

A late-middle-aged man came into my surgery saying he had a bit of tummy ache. His pulse was rapid, his blood pressure low and his abdomen rock hard. He was walking about with a perforated appendix. Another man rang towards the end of evening surgery asking for a call in the morning, as his wife was unwell. I offered to go that evening. ‘We don’t want to trouble you, doctor.’ I left for the house as soon as surgery was finished and found a greatly distressed woman with advanced heart failure.

It was during this time that I became an IPM seminar leader. The first group I led was in Bristol where there were enough applicants to start two groups. Elizabeth Gregson, my stalwart friend who had climbed the high rise stairs in Liverpool to deliver condoms, led the second one. The power of group dynamics was shown very clearly when one of her members decided to come to a session I was leading. She was an outsider in my group, who had already bonded with some force. They gave her a rough ride. I was too inexperienced to be fully aware of what was happening and did not intervene appropriately. Luckily she is a strong person who could look after herself.

One way in which Tom Main tried to focus the training on our doctoring was to insist that during the seminar and the leaders’ workshops we called each other Doctor so and so, not Ruth or Mary or Heather. He did this deliberately and openly, not to be nice or nasty but to address the professional ego. At the end of the training session we could revert to the terms used between friends. In today’s world where such familiarity is ubiquitous, used by one’s bank manager, solicitor and milkman the rule is archaic and would do nothing but arouse suspicion or mirth.

But I still feel strongly about the subject. One of my clinic secretaries sent an appointment to a referred patient addressing her
as Susan although the referral letter had called her Miss Blank. I was furious, and not a bit surprised when she did not arrive to see me. I learned from the letter that she was an unmarried teacher in her forties who had never been able to have sex. Of all people to patronise in that way!

After a couple of years Elizabeth retired and I took over her parttime lectureship. When she held the post it was called ‘lectureship in family planning’. I insisting on adding ‘and psychosexual medicine’ to try and raise the profile of the work. The job included a psychosexual clinic in gynaecology outpatients. By this time more men were being referred to me, which was very awkward as the electronic system of registration did not include ‘Mr’. A man often had to suffer the double embarrassment of being the only male in the waiting room and of being called over the Tannoy as ‘Ms’. I soon insisted that I would fetch each patient myself, whatever their sex.

I went on to lead several groups in various parts of the country, including one of obstetric and gynaecological physiotherapists. Despite the fact that their role requires them to give a lot of advice they were responsive to the idea that they could learn to listen in the consultation. Many of their patients were postnatal, with bladder and pelvic floor problems. The idea of ‘de-briefing’ is useful after childbirth. One definition of the word is ‘to relive an experience with someone else to make sense of it’. Feelings about the labour and delivery may take a few weeks to develop and the physiotherapist is ideally placed to listen to the woman’s story. I was sad to hear recently that no training in this aspect of their work has been included in their curriculum.

My life had become over-full and the time had come to give up my general practice work once again. I never regretted my short foray back into what I still thought of as the ‘real’ medical world, for it gave me more legitimacy to lead groups where an increasing number of the trainees were combining their family planning and psychosexual work with general practice or hospital medicine. These doctors were learning to integrate their psychosexual work into their healing role. However, I can’t help wondering if the deep
understanding of emotional problems, unearthed by the detailed work of those who remained focused in family planning and psychosexual medicine, would be possible in today’s management-driven NHS.

16

Taking the Reins

After my father’s funeral Arthur and Sylvia went home. I stayed on for several days. During that strange interlude I became the adult to my mother for the first and only time in my life. I was the one to suggest we should take my father’s blankets to be cleaned, I chose what we would eat, and opened and listed the condolence letters for her to answer later. This position of power was surprisingly satisfying. My mother had always been the boss of the household, and of our lives, with no chink in her efficiency that would allow her children to provide genuine help. Now, in her grief, my mother truly relied on me and her need made me stronger. But my own grief demanded some outlet. Using my dog Bess as an excuse for a walk, I took an hour off every afternoon. Striding down gypsy lane and across the fields where we had walked so often as children I wept, not just for the loss of my father but for my departed childhood. The pond with the bullrushes at the end of the second field remained as I remembered it. The pill-box left from the war still smelt of stale urine. The path went over a tributary of the river Avon and down the side of the Nestlé factory as it always had done. I encouraged my tears, for they relieved the ache inside, but it was easy to stop them at will, in time to allow my eyes to recover before facing my mother again.

One day our friends Dilla and Alan Roberton, with whom we had spent holidays in Cornwall, arrived to take me out to a pub lunch. During that meal I learned something of the needs of the carer. Until then every fibre of my body had been concentrated on helping
my mother survive, hour by hour. The warmth of their concern and the opportunity to talk about my own grief gave me the strength to go on.

After about ten days my mother seized back the reins of her life and I went home to Ralph. It was not long before she threw herself into converting the surgeries at Green Gables into a flat where she had a selection of different tenants. Then she built a smaller house in the grounds. A pleasant couple bought our family home, but they eventually sold it to a developer, who divided it into four flats and built seven houses in our lovely garden.

For me, the moment of parting from the house I loved so much came when all the furniture had been removed. I was standing at the nursery window looking out at the empty swimming pool with its cracked walls. I remembered the soggy leaves that always lurked at the bottom, full of worms, making me afraid to put my feet down. (My parents didn’t acquire a vacuum pump till many years after I had left home.) As I stood there, a single sob shook my body. One of Daisy’s nieces, who still helped in the house, was by my side. She laid a hand on my shoulder but said nothing. There was nothing to say.

My mother had always enjoyed planning houses and insisted on having the new house designed round her favourite furniture. This included her Globe Wernicke bookcases, bed, oak desk, and her ‘byme’, a small mahogany piece with shelves, a drawer and cupboard opening on both sides and made to stand between two beds. The resultant house was a plain building, light but utilitarian. Her architect, who had wanted an elegant house with windows in the shape of cabin portholes, lost every battle.

During my mother’s time in that house, my father’s cousin Sylvia Guthrie, who had been such a stalwart support when my father died, became very frail. I had always been in awe of her. Her husband had died early in her life but despite being a single woman she had been allowed to adopt two children. The rules were not so rigid in those days and the fact that she was a respected paediatrician in Manchester might have helped. My parents had chosen her as one of my
Godmothers. After taking Arthur to be christened my mother had felt physically sick, so when it was my turn she had delegated the task to Sylvia. Biz was never christened and I often wondered if she felt a bit deprived.

It was not until Sylvia was fading in body and mind, when I visited her in her home, that I appreciated the person she was. I found her sitting up in bed reading one of Enid Blyton’s ‘Famous Five’ adventures. She had been something of a legend in the paediatric world and the humility with which she accepted that she could no longer keep up with the latest medical advances, yet had found a book she could still read and enjoy, was impressive. She told me she had been close to Michael Balint in her youth but to my great disappointment was not willing or able to elaborate on one of the most important gurus in my life.

On moving back to Bath in 1980 I had found the local accent very evocative. My gardener and many of the girls who served in the shops spoke in Daisy’s voice, carrying me back to my earliest memories. Travelling to London, on what used to be the Great Western Railway, the first stop was Chippenham. For years I looked out of the window on every journey, searching the entrance where my father would stand, hat on his head and gloves in his hand, waiting for me to arrive home from school or university. He was always sent to fetch us, for my mother hated meetings and partings as much as I do.

During the last years of her life Daisy continued to live with another of her nieces in Chippenham. I only saw her occasionally, though she was an integral part of the person I am, present in the deeper recesses of my mind and my memory. Eventually she became very frail and was moved into a care home. The day before she died I took my mother to visit her. We were shocked to find her semi-conscious, but dressed and sitting outside. Protocol demanded that old people should be mobilised at all cost; but we were sad she had not been allowed to lie peacefully in her bed for her last few hours. My mother was upset that Daisy was dying first. In her will
she had left all her tweed coats to this person who had given the most loyal service to the whole family over so many years. What would she do with the coats now?

Ever since Daisy first arrived at Green Gables, and I had peeped at her round the banisters, there had been a love–hate relationship between the two women. My mother was often irritated by her, especially when she insisted on continuing the story she was telling to the bitter end, never deterred by the interruptions that would have silenced others. But she was fond of her and was totally reliant on her practical help during the war. Daisy admired her employer’s intelligence and dedication to her work. Neither woman would have admitted how dependent they were on the other.

Needless to say, my mother would not consider going to her funeral. I had to represent the family, at the same crematorium where we had taken my father. In sharp contrast to his minimalist ceremony, Daisy’s service was well attended. I managed to get a seat by the wide window where my mind could escape over the rolling Somerset hills. All such sorrow-filled places should have an expansive vista. Despite my atheism – not as rabid as my mother’s for I am not anti-church, just not able to believe in an ‘out-there’ God – my favourite devotional line, based on the 121st psalm and set to music by Mendelssohn, is ‘Lift thine eyes to the mountains whence cometh help’. The hills, together with the intervening valleys and their rivers, hold for me that sense of mystery that others find in religious belief.

That day of Daisy’s funeral I again witnessed the tradition of placing the flowers from the top of the coffin on the ground in the courtyard, in the shape of a body. Her pile lay as one of a row with those of others who had been cremated during the day. The custom was for the mourners to linger, reading the messages of condolence while talking, at times with some animation. When Arthur and I had scuttled away from my father’s dispatch there had been no such niceties, for we had no flowers and no mourners other than ourselves.

As I stood awkwardly among Daisy’s friends and relations a
middle-aged man approached me. ‘I think you are Ruth, aren’t you? I remember your house and parents so well.’ He was one of Daisy’s many cousins and told me the following story with glee. Remembering seemed to give him as much pleasure and amusement as listening gave me.

‘During the war, when I was about seven, I was walking up your surgery path. You remember, it was a long path used by your father’s patients to get to the surgery entrance. We always went that way when we visited Daisy.’

I nodded, enjoying his memory of the path that I had used so often on the obligatory afternoon walk as a child.

‘I had a friend with me, young Jack, he’s dead now, rode his motorbike into a wall. As we were going up the slope, kicking the leaves, he saw something at the side of the path. It was like a round tube. We knew it must be an unexploded bomb.’ He paused for effect. In the solemn surroundings I had to suppress a giggle.