Growing Into Medicine (13 page)

Leaving almost all our belongings behind in Portsmouth, we moved into a furnished flat in a doctor’s house in Hendon. We had the place in return for my work in the surgery below. Soon after we moved in I was wandering round the medical bookshop H K Lewis in Gower Street and picked up a book called
The Doctor, His Patient and the Illness
. I stood still between the bookshelves as I turned the pages. Here was a writer who was asking the questions I had not even formed, about the workings of doctors and patients together. I bought the book, continued reading at home and then glanced at the latest
British Medical Journal
. There in the advertisements was a notice about a seminar to be run by the author of the book I had just put
down, Dr Michael Balint, starting the next week. It felt like more than a coincidence and Ralph was excited for me. We now had a shared interest in what went on between people; his focus on those in trouble with the law, mine on those in trouble with their health.

Re-reading Balint’s book all these years later I am reminded that his original aim was to study the effect of the ‘drug doctor’, to help us to be aware of how we use ourselves in the consultation. Much of the first part of Balint’s book is devoted to ways of helping the patient to accept that there might be an emotional cause for the physical symptoms. In the face of the present belief in ‘stress’ as the cause for many things, the idea seems dated. Now there could be a danger that patients put symptoms of serious illness such as cancer down to stress and delay seeking a reliable opinion.

Two other ideas dominated the book. One was what he called the ‘collusion of anonymity’, where a worried doctor referred the anxious patient to one specialist after another, thus avoiding total responsibility. In the present system, where patients often sign on with a practice rather than an individual doctor, the opportunity for continuous personal care is so small that such a concept can have little more than historical interest. Shared care is built into the system. Perhaps the same applies to Balint’s concept of what he called the doctor’s ‘Apostolic function’. By this he meant that in his effort to do his best for the patient, the doctor was driven to impart his own understanding of the boundaries of the illness. For instance, what symptoms warranted anxiety, what pain should be borne. Unless the doctor could become aware of his/her own belief system the approach could not be tailored to individual patients according to their needs.

Balint was experimenting with the idea of training GPs to use psychotherapy in their work, encouraging them to offer patients long interviews, up to as many as twenty meetings. The devotion of so much time to one patient provides an example of the conflicting interests of the individual and the rest of the practice population. Later, his studies of work within the short consultation were published in the important book
Six Minutes for the Patient
.

For me, the experience of studying the emotions of the doctor in response to a patient was revelatory. For the first time the doctor was allowed to have feelings; but the emphasis was not on those feelings for their own sake but for any light they could throw on the patient’s condition. These ideas were developed further by Tom Main in the Institute of Psychosexual Medicine (IPM), and were to become a very important part of my work.

For the rest of that academic year I attended the seminars and did various GP locum jobs. One practice in the east of the city horrified me by the amount of undiagnosed pathology that I found. On the first morning it became clear that the doctor was a great believer in homoeopathic medicine, which he used in place of any traditional medical work. He ignored serious symptoms and never examined his patients. My horror was tempered by the pleasure of recognising the signs. During the week I discovered three advanced cancers, a case of florid heart failure, body lice and varicose ulcers, all obvious and easy to diagnose once the patient removed some clothing. Ever since I had qualified I had been afraid of missing signs; I was no good at hearing soft heart murmurs and could not always see the ear drum. Now I knew that I was not totally worthless as a doctor. I was beginning to believe that medicine had really been my chosen career.

The Asian flu epidemic of 1956/8, which started in China, is estimated to have killed two million people worldwide. This did not put it in the same category as the 1918 pandemic where the number was 50–100 million but it led to enormous visiting lists for me. I was by now working for another practice in Hendon. We might do thirty or more visits in a day, often not finishing until late in the evening. Many of the calls were easy, the most important aspect being to assess how ill the patient was. I discovered that I could never judge the seriousness on the phone, and I am amazed at how doctors and nurses now give so much advice without seeing the patient. Those people who sounded calm were often the most severely ill, while those who set my heart racing with anxiety as I reached for the door bell, especially parents, could be tending children who were happily eating and playing. Again I lacked confidence and added to my
workload by often visiting the same patient two or three times a day. Admission to hospital was extremely difficult and a last resort. By the end of the day I could hardly speak for exhaustion.

Despite the fatigue I remained fit the whole time, only succumbing ignominiously to mumps the following spring, not long before our summer holiday. I phoned home and heard my mother calling, ‘Ruth has mumps, isn’t it lovely, she’s coming home.’ I did not feel particularly lovely but the warmth of her welcome was sincere, even if her words and deeds were not always tactful. I found a jug of home-squeezed lemon juice, one of her specialities, waiting by my bed. Nothing could be better designed to make my swollen parotid glands ache as they laboured to produce the rush of saliva stimulated by acidic lemons.

However the side effect of that infection
was
lovely. Ralph and I went to France, driving down through the sea of lavender growing in eastern Provence. I had no idea such an expanse existed and had never seen such profusion. The perfume reminded me of drying seed heads in the sun to make lavender bags, an occupation beloved of my mother, my grandmother and myself. Those wide stretches of colour, as blue as the Mediterranean sky, evoked the memories with added force. On our return we went back to Portsmouth to collect our belongings, which had in the meantime become covered in mould. I visited Dr Burnham-Slipper and asked him to arrange a pregnancy test, for I did not trust the one I had bought from the chemist. After a couple of days he rang to say, ‘It is weakly positive, congratulations.’ I knew he would not raise my hopes without due cause and had the courage to believe the unexpected had, after six years, happened at last. I had managed to conceive somewhere in one of those small French hotels, chosen from the Michelin guide with a black bird,
tranquille
, or a red bird
triès tranquille
, among those heady fields.

Mumps is known to carry a risk of inflammation of the testes in adult men and occasionally of the ovaries in women. Although I had no abdominal symptoms I am convinced that my ovaries had been mildly affected, just enough to soften their covering and allow one
egg cell to pop out. At about that time I heard of two medical wives who had conceived following mumps. Alas, I did not follow up my idea or collect the dates and details necessary to write a paper. But I was left with a lingering regret that a second dose of mumps was almost unheard of. Without that fillip to my ovaries I never managed to conceive again.

9

Motherhood

Once we had wiped the mould off what shoes and clothes could be saved from our flat in Portsmouth, our next move went smoothly. I felt very well and suffered no morning sickness. We had not accumulated many belongings in the small flat and had not yet acquired any animals. The semi-detached house which had been allocated to us at Hewell Grange in Worcestershire had three bedrooms and felt palatial. As soon as we had settled in I found two practices where they needed occasional help with surgeries. I was happy to be working part-time, able to adapt my hours as my girth increased.

I returned to Chippenham for the birth. It is now considered unprofessional to be a doctor to one’s own family but we trusted no obstetrician more than our father. He delivered all three of his children and two grandchildren. Biz came from Virginia USA to have her first child. Before and during the war several friends and relations had stayed in Green Gables to have their babies. They were given the spare room and a midwife moved into the house, which became a temporary maternity home. Father had his instruments and dressings sterilised at the hospital in large brown drums.

For at least two weeks the household would revolve around the room where the mother rested, gave birth and then recuperated. Daisy and the second maid cooked and cleaned, the gardener picked the youngest vegetables, the secretary worked to keep the patients in the surgeries as quiet as possible and even the dogs and cats seemed to sense that something important was happening. It was without doubt not only safer than giving birth among the bombs in London
but cleaner and more hygienic than the most expensive maternity home. My mother supervised the whole operation, ensuring that we children were visiting friends at the time of the birth.

Only one of the deliveries caused my father any problems. His favourite sister, my Aunt Pip, had trouble with her first child. With great skill my father delivered her with the help of forceps but sadly the baby’s face was scarred. Later plastic surgery made the marks virtually invisible but my cousin must have been painfully aware of them during her childhood. My father took consolation from the fact that she had clearly suffered no brain damage, for she went on to become a successful doctor and mother.

By the time Helen was due, babies were no longer born in my parental home. My father had been appointed senior medical officer at Greenways, a new maternity home on the outskirts of Chippenham. A couple of days after she was due I heard my father telling the consultant on the phone that this was ‘a precious baby’ and he did not want to hang about. All babies are precious but the strain of being responsible for his first grandchild, for whom we had all waited six years, was great.

The consultant induced her and I went into labour within hours. I managed the first stage with Matron herself by my side, helped by my father’s special chlorodyne tipple. He arrived at 6 a.m. to deliver her himself – and I heard again his standard, ‘Ah, I see it is a little Mary.’

Ralph arrived for a brief visit. In those days husbands were not expected to be present at the birth of their children, which suited us both fine. He would have found the whole thing unbearable, and I needed to be free to cope with myself without worrying about him. Ralph liked to be in situations with which he was familiar. He was good at weddings, his experience as best man on several occasions giving him confidence, but in a medical setting he was out of his comfort zone. He managed to hold his daughter briefly, intrigued but frightened. We decided on her name but after a couple of hours he escaped back to his borstal boys. Part of me wished he had stayed longer, wished that we, the two of us who were now his family, came
higher on his agenda – but without him it was easier for me to sink back into a dependent relationship with my parents. All my life I have found it difficult to be with more than one loved person at the same time, needing to adapt differently to each person.

Most of the rooms in the maternity home had several beds but one was a single, reserved for those with medical problems. When I was admitted there was no one with such a need, so I was given the privilege of privacy and beautiful views over the surrounding countryside through windows on two sides. It was a magical place to lie on that morning, 2 May 1959. Summer had arrived overnight, a cuckoo called, lambs shook their tails and a thrush flew by with her beak full of worms for her young. For the first day or two I felt a great peace, at one with fecund nature.

The skill of the nursing and the detailed care that I received during and after the birth reminded me that I had wanted to spend my life making people comfortable. I had never been in hospital and had not appreciated the relief of a new-made bed. Matron had a particular way of arranging the pillows that provided maximum support. She and the other staff were adept at applying binders round tender breasts, just firm enough to support them without reducing the supply of milk. The routine was to leave the babies with the mothers during the day but take them to the nursery at night, allowing time for bonding but giving the mother her undisturbed sleep at night: a perfect arrangement.

During her first few days Helen was a sleepy baby. Maybe the induction of labour had forced her arrival a day or two before she was ready. By the evening of the third day, when the normal post-partum blues had set in, I was getting desperate and was mortified by a strong impulse to shake the tiny bundle that refused to suck. Late in the evening I heard my father’s voice and thought it was a miracle that he had arrived in response to my distress. When his voice faded I realised he had been called in to see another patient. Knowing he was in the building was a comfort and in due course he wandered into my room and sat in the visitor’s chair. I burst into tears. He took little notice but talked about the small doing of his
day, just as he had done when Biz and I had screamed in our joint tantrums. In due course, perhaps because I relaxed and was no longer trying to force her, Helen woke up and took a good feed.

In the obstetric book my father wrote with Will Nixon, published in 1953, the idea of early mobilisation after childbirth was just becoming fashionable. They give details of a new regime that suggests swinging the legs over the side of the bed on the first day, standing for three minutes on the second, walking round the bed on the third and journeying to the toilet on the fourth. The mother should gradually progress to discharge on day ten, though a stay of fourteen days was preferable so that lactation could be better established. In the book they discuss the practice in less-developed societies of treating labour as an incident in the day’s work. They did believe we had a lot to learn from them, but their advice was still cautious. I fear the pendulum has now swung too far the other way, especially where family support is inadequate. If discharged after a stay of twelve or fourteen hours the mother may be expected to look after the house and other children, tasks I would have found quite impossible.