(2013) Looks Could Kill (6 page)

November 1983

Once Emma had started her first clinical year, medicine suddenly opened up and seemed to escape from the confines of the dissecting room and the endless textbooks filling her shelves. But she found herself frustrated by the constant moving on as she went from one clinical attachment to another. And the never-ending making and breaking of relationships with staff and patients seemed at odds with the therapeutic bond that’s meant to develop over time between doctor and patient.

There’s no doubt that Emma’s self-harming went a little off the rails during this time and she became a well-known customer at the local Boots, stocking up on steri-strips and plasters. She’d learnt from an early age that drawing attention to her self-harming usually caused more problems than it solved, so self-presenting to an A&E department was a definite no-no.

So, being so close to home, psychiatry held something of a morbid fascination for Emma.

One Friday afternoon, when Emma really wished she was doing something entirely different, she found herself waiting to see a new patient that she’d then have to present to the senior registrar. She’d seen a referral letter from a GP, but it was the typical one-liner – “This woman is depressed, please do the needful” – from an overworked, single-handed GP, which gave virtually nothing away.

“Hello, you must be Julia Thompson,” said Emma, with a beaming smile. “I’m Emma Jones, a medical student, and I’ve been asked to take a full history and do a mental state examination.”

Emma realised as soon as the words escaped from her mouth that that was a bad start, although that is what the senior registrar had told her to do.

“Well, no insult meant, love, but I was told I’d be seeing the consultant,” said Mrs Thompson.

“Oh, yes, you will see the senior registrar, but he asked me to see you first.”

“No insult meant, love, but you don’t look old enough to be my daughter, and anyway, I was told I’d see the consultant.”

After this unfortunate introductory sparing, which is commonplace when medical students get asked to see patients without them receiving some forewarning, the two of them reached an agreement that she would talk to Emma for a bit, but that she would have to leave soon to top up the parking meter.

“So, Mrs Thompson, can you tell me what brings you here today?” asked Emma, using the open-ended introductory question suggested in her psychiatry hand-out.

“Well, it’s like, it’s this thing that, I don’t know how to put it, but it’s like I don’t, you know what I mean, don’t you?”

Emma was going to ask her to repeat what she’d just said, but she decided on a different tack in the hope that it would resolve her patient’s expressive dysphasia.

“I’ve got a letter from your GP here, and it mentions you being depressed. Can you tell me about that?”

“Well, it’s like, it’s this thing that, I don’t know how to put it, but it’s like I don’t, you know what I mean, don’t you?”

Now someone once told Emma that when people are as tongue-tied as this poor woman clearly was, it’s usually because they’re embarrassed about something. And reading between the lines, Emma got the impression that the embarrassment was related to something ‘down there’. Emma caught her eye and the wave of embarrassment she experienced immediately confirmed her feminine intuition.

“Now, Mrs Thompson, I’m going to make a stab in the dark, but I think you’re embarrassed about something and that you haven’t been able to talk to anyone about it, and it’s that what’s made your GP think you’re depressed. Am I right?”

And that unleashed the floodgates. It turned out that her husband was a “philanderer” and he accused her for being a “frigid cow”, which is why he had to “get it” elsewhere.

As far as Emma was concerned, there wasn’t actually the slightest hint of clinical depression, just utter frustration with an appalling husband who seemed to enjoy mistreating her in any way he could. Emma couldn’t see much point in doing a full history and mental state examination, but she did it anyway to keep the senior registrar happy.

So Emma presented her case to the senior registrar and then he invited the patient into his consulting room so that he could confirm her findings.

“So, Mrs Thompson, I gather from your GP that you’ve been feeling depressed.”

“Yes, terribly depressed, doctor. I can’t sleep, I can’t eat, I can’t concentrate, I’m crying all the time and I’ve got no interest in anything. To be honest, I’ve even thought of, you know, doing something.”

“Do you mean like harming yourself or even taking your own life?”

“To be truthful, doctor, I have.”

So the senior registrar concluded that the GP had been right all along and started her on an antidepressant.

The senior registrar told Emma that the key learning point from that case was to accurately diagnose depression. The learning point that Emma took home that afternoon is that sometimes patients will say anything in order to get a prescription.

And Emma decided that the parking meter ploy was an excellent way for a patient to do a bit of boundary setting.

October 1984

It’s generally assumed that female medical students will take to obstetrics like ducks to water. The reality for Emma was far different. Distant memories of a bustling woman in brown uniform and sensible shoes at her own birth loomed large for her. And as she entered the antenatal clinic, who should loom large but a bustling woman in brown uniform and sensible shoes. 

“You!” she said.

“Hello, I’m Emma Jones, a 4
year medical student. Where should I go?”

“Well, not here for a start; we’re far too busy.” And the bustling woman in brown uniform and sensible shoes bustled off.

Emma eventually negotiated her way out of the overcrowded antenatal clinic, only just avoiding being squashed between a Scylla and Charybdis of two very pregnant abdomens.

The students’ introduction to obstetrics took place in a seminar room that doubled up as the ‘birth training centre’ and seemed to be full of obstetric models displaying babies in open abdomens that were crying out for some artist to  copy and transform into a twenty-foot piece of art.

Emma and her three colleagues were divided between midwives and they were told that their task was to follow through all the women who presented; from stepping out of the car or ambulance to going home with baby plus bouquets of flowers, helium balloons saying “It’s a girl/boy” and the shell-shocked father. Given that the average duration of labour for a first pregnancy is 16 hours, it rapidly dawned on them that this could mean four weeks of total sleep deprivation.

But the curious thing is that Emma’s experience in that four weeks of obstetrics was one of the most meaningful she had throughout her three years as a clinical student.

And the very best was her first labour.

Emma walked into the labour suite, found the delivery room she’d been allocated to, knocked on, and warily poked her head around the door, not knowing quite what to expect.

The young couple she saw were calmly lying together on the birthing couch and spraying each other with Evian water.

“Oh, hi,” said Emma, “I hope I’m not disturbing you. I’m Emma, a medical student and I’ve been asked to stay with you for your labour.”

“Come in and join the party,” said the very handsome husband. “I’m Tim and this is Jemma plus one. Would you like a spray of Evian water? Sparkling or still?”

And despite that most unorthodox start, Jemma and Tim turned out to be a delightful couple who were also opera singers when they weren’t having babies.

As the labour progressed, the sound of their singing spread around the labour suite and Emma kept on having to close the door on people wanting to find out the source of the singing. By the time the third stage came around, their voices were getting rather ragged, but they managed to retain a sufficient reserve to end the labour with a duet from Puccini’s ‘La Boheme’ as the baby was actually born. And to round it off, they asked for the placenta to be put in a doggy bag as they planned to fry it with shallots and garlic.

June 1987

Emma collected a small package from her pigeon-hole on the way back to her room. She had no idea what it was but her name had a ‘Dr’ in front of it. That surprised her as the Finals results had only just come out. Someone with friends in high places, she thought.

As she came back into her room, Emma realised that she’d miss it, despite its pokiness. She was glad that she’d been able to move back into a college room for her last clinical year as it gave her a stability that she’d found difficult to find when living in lodgings.

Most of her possessions were now in boxes ready to go back to Hindhead until she started her first house job. Emma reflected that putting things in boxes had also been her way of finally making sense of medicine and which had undoubtedly helped her pass her exams. Emma had also learnt a lot from a neurologist who’d asked her what Ockham’s razor was and then proceeded to give her an erudite mini-lecture about William of Ockham and his principle that the simplest solution was usually the best. She’d used Ockham’s razor for her medical long case and had been spot-on with her diagnosis. But she’d also been helped by the telling look in her patient’s eyes which had confirmed what she thought. She was also relieved that Ockham’s razor had pretty much replaced her own.

Emma looked out of the window at the college chapel. Although she still occasionally imagined the steeple turning into a spaceship and taking off into outer space, she didn’t really mind that much if religion stayed behind. Better a belief in something than in nothing, she thought.

She turned her attention to the mysterious packet. The writing on it was in italics and unusually beautiful. She tore off the paper and found a strange, five-inch square, thin plastic case with the title ‘La Boheme’ on it and a cover photo of a handsome young couple whom she immediately recognised as Tim and Jemma, the opera singers. She wasn’t quite sure what to make of the silver disk inside the case but she was mesmerised by the way the surface diffracted light and shimmered like a butterfly’s wings. It suddenly dawned on her that she was holding a compact disc, a replacement for the LP that had only just come on the market. Sadly, she realised that it would probably take months of salary slips before she’d be able to afford the equipment to play it on. In addition to the compact disc, there was also a small photo of Tim and Jemma and their baby. On the back there was the same italic writing and Jemma read:

‘Dear Jemma,

Our first ever compact disc! We’re thinking of you.

Kindest regards,

Tim, Jemma and Sian

P.S. The placentaà la française was heavenly!’

Emma thought that sooner or later she’d be returning to Oxford.

August 1987

The introduction for house officers starting their first surgical job was held in a severely raked lecture theatre in the bowels of the hospital. It looked as if it had been an operating theatre at some point in its past and smelt of carbolic.  A tall, distinguished looking man in a Saville Row suit entered, with sleek grey hair and bow tie, followed by a mini-me version, who Emma guessed was his registrar. 

“Good morning, doctors. My name is Professor Cuthbertson and I am Head of Surgery.  Today is the most important day of your career. You will be taking the first step from clinical virginity to consummate practitioner. You will do this by learning not from books but from patients and the operating theatre. You will discover that surgery is a craft demanding a lifetime of practice and dedication. You can give an amateur a Stradivarius but it will only be a violin; only a virtuoso will make it sing. Surgeons must strive to be both the conductor and virtuoso of their instrument. Although you may be only mere beginners in the art, I will expect nothing less than the highest standards of professionalism. Hard work will be expected and rewarded, but excuses will not be accepted. You have all been allocated to firms and your work starts after this meeting. Now, where is Dr Jones?”

“That’s me, sir,” said Emma.

“Dr Jones, matron has asked that you present yourself to her after this meeting.”

There was a giggle from other house officers. Emma felt singled out for no reason other than him using her to exert his superiority.

“Very well. Please collect your badges, white coats and bleeps. Ward rounds are at 8:00 a.m. sharp and I expect you to know all your patients. Good day to you all.”

“Good day, sir,” the house officers said in perfect synchrony.

Professor Cuthbertson walked out imperiously, his mini-me in tow.

A baptism of fire is what Emma expected and a baptism of fire is what she received. Unfortunately, Prof Cuthbertson was the consultant on her surgical firm.

Emma made her way to Ward A1, which happened to be the main ward for general surgery. Double doors opened onto a cavernous space with beds on both sides and a nurses’ station in the centre. A smell of antiseptic with undertones of urine and anaerobic infection pervaded the space. Patients were male and most seemed to be elderly.

“You!” a voice boomed.

Emma turned suddenly to be confronted by a bloated figure in blue, who was obviously the matron judging by her elaborate headdress. It’s Hattie Jacques, Emma thought.

“Where’s your coat and badge?” she asked.

“I wasn’t told anything about that; just to come and see you before I picked up my bleep,” said Emma.

“Doctor, your professional identity comes first, so I suggest you go to medical staffing and only return to the ward when you are suitably attired.”

Matron retreated into her office, the view of her stern as formidable as her aft. It reminded Emma of her mother in her more pigged-out phase, except that her mother wore hand-crocheted ethnic tents rather than starched blue uniforms.