When I Wasn’t Looking

Just when I wasn’t looking, my mother became old.

     I’m not sure when it was. Perhaps it was yesterday, whilst I was on the telephone or last night, as I mended the fire and my back was turned.

     But when I looked up again, she had changed.

     She has become shrunken and creased and has the jaw of an old lady, which quarrels with itself as she eats. A moment before, she had just been my mother but now she is small and transparent and I want to put my arms around her in case she should break. But my arms stay where they are. Not because I’m proud or embarrassed, but because I’m angry with her for being small and transparent and I’m angry with myself, because I can’t remember when it happened.

     When I was little, my mother was comfortable and wise. We would stand together in the kitchen and she would zip me into my anorak, right up the neck, even though I wriggled and protested and told her I was too warm.

     “It will rain later,” she said.

     And it always did.

     On days which were full of spring sunshine, she would still slide my hands into gloves and twist a scarf around my neck.

     “You’ll be cold otherwise,” she said.

     And I always was.

     Other children had brothers and sisters and cats and dogs, but I had my mother all to myself and I was full and satisfied. Now, the shine of being an only child has become dull. Now it tastes bitter and resentful. Now I want to share.

     I’m not sure when it happened, but one day I stopped feeding my life to her. Instead, I give her fragments, pieces she will easily understand. Not platefuls of information which confuse us both and force me to remember that she is old and transparent. But the little pieces aren’t enough and she is drifting further away from me. Now, instead of talking to my mother, I talk to the steering wheel and the bathroom mirror and the photograph of my dead father, who sits on the mantelpiece and watches us age without him.

     Today we are going out. I organise and check and feed her pieces of information. I slide her hands into gloves and twist a scarf around her neck.

     We stand together in the kitchen and she looks at me with old, transparent eyes. “Do you think I’ll need a coat?” she asks.

     And I’m frightened to look away.

A Beautiful Game

You died at six-thirty in the evening, whilst no one was looking.

Whilst nurses pushed a drugs trolley and doctors shuffled notes and the other patients settled down to watch the second half. When everyone was busy doing something else, it was then you decided to leave. Silently, without fuss or ceremony, and without any of us even noticing that you were no longer there.

You’d had enough of the ward and the blood pressure machine and the cold cups of tea, which formed a queue on the bedside table. You had grown tired of the circular ward rounds and the doctors who ebbed and flowed, trying to find a reason for their own existence.

 When the consultant read out the results of your scan, you turned to him and said ‘so I’m a goner?’ and you stared into the middle distance until the words found your eyes. Then I watched you shake the consultant’s hand, as though you both had made a pact on God’s behalf.

You didn’t cry or argue or search for hope. I wanted to cry and argue and search for hope in your place, but you said that fighting with the referee never got anyone anywhere. Sometimes, it was better just to leave the pitch with your head held high, like a gentleman.

And I was angry, because you never said goodbye.

I had stood by your bed an hour earlier and we watched a perfect goal on the flat screen television which played in a corner of the ward.

“You have to pick your moment and choose your spot,” you said to me. “That’s the secret.”

I was angry, because you never said goodbye, but it was only later, when I remembered the goal, it was only then I realised that you already had.

I just didn’t hear it.

There was no family to ring. No one to apologise to. No one needed a bereavement pack to tell them how to cope.

“Aww, that’s so sad,” said the nurse. She didn’t lift her eyes from Heat magazine. “I’ll ring the mortuary in a minute. I’m on my break.”

I will miss you.

Even though the man at the nursing home had to ask me to spell your name and a key still hung in the latch of your empty locker. Even though other people’s relatives always borrowed the empty, plastic chair by the side of your bed and no telephone ever interrupted us with questions about what kind of night you’d had.

Now, each time I walk on to the ward and look over to see a stranger lying there, I will miss you again and again. I’m not sure how these things work, but I hope you know that someone cried for you. I hope you know that your life was worth that much. And yet I hate myself for such selfish tears. Tears which reassure me that you mattered and tears for my own inadequacy, because I know I could never leave with such grace and dignity.

And because I didn’t say my goodbye, I will write for you instead. Somehow, I think by writing, the world will be vindicated. These words are an absolution for the empty, plastic chair and the silent telephone and by committing you to paper, in some small corner of the earth, you will always be remembered.

Because you should always be remembered.

You left the pitch with your head held high, like a gentleman.

And you were the bravest man I ever met.

Kodak Moments

Unfortunately, I can cry at pretty much anything.

I cry at contestants winning prizes on television quiz shows, black and white photographs of people I don’t know and an old man shuffling around Sainsbury’s with half a loaf of bread in a wire basket. Certain pieces of music can take me from completely fine to an absolute wreck in approximately thirty seconds.

When I was twelve years old, I asked my piano teacher if I could learn Chopin’s Nocturne Op.9 No.2. She refused my (rather ambitious) request and told me that I couldn’t play Chopin until I’d lived. At the time, I was hugely resentful and refused to practice arpeggios in an act of defiance. Now, sadly, I can say with absolute certainty that she was completely correct. I can also say with absolute certainty, that I sometimes feel as though I have lived just a little too much.

Of course, I don’t cry for the perfect combination of crotchets and quavers. Nor do I cry for the Carter family who have won a three week holiday in Barbados. I cry for the Kodak moments, the small snippets of other people’s lives which I take home with me every night and if you walk a circuit of any hospital, you will find many of these moments in wards and clinics and hidden behind paper thin curtains in anonymous cubicles.

I cry for the family who walk down the hospital corridor at 3am, pale and shocked, with their arms wrapped around each other in case one of them should fall. The man who sits in intensive care every day, reading to a wife who doesn’t hear his voice and will never hear his voice again. The mother who tries to sleep on a chair, with her hand reaching out through the bars of a cot. I cry for the little girl in the cancer clinic, who is told she doesn’t ever have to come back to hospital again and she can go to Disneyland instead and I especially cry when I think of the battle on her parents’ faces as they try to join in with her excitement.

I have collected so many Kodak moments over the years and they fill album after album in my head. I have so many albums now, I am beginning to wonder if I am cut from the right cloth to practice medicine.

I am told compassion is a wonderful thing. It’s something to be desired and applauded. But compassion will eat away at your sanity. It will make you pull up in a layby on the journey home, because you can no longer see the road for tears and it will creep through your mind in the darkness and keep you from your sleep.

In my first job as a doctor, an expected death occurred on the ward and I went to my consultant’s office in order to inform him.

“Lawrence has died!” I said, in a most unprofessional, junior doctor way.

My consultant didn’t reply, but continued with his very important consultant-type paperwork. After a few minutes, he looked up and frowned.

“Ah. You mean the bowel cancer in side room four has died?”

“Yes,” I repeated, “Lawrence has died.”

I hated him for the rest of the rotation. It’s only now that I realise even the most compassionate of physicians must trade at least a layer of their humanity in order to survive.

At the moment, this is not an exchange I am willing to make.

And if you are not able to make this sacrifice, you will continue to collect albums full of Kodak moments and burst into tears at Family Fortunes. You will also sometimes play Chopin’s Nocturne Op.9 No.2. over and over and over again to rid yourself of the layers of other people’s misery which fill your mind.

And the cloth from which you are cut will begin to suffocate you.

Elephants

Visiting hours on the maternity ward are pure bedlam. A nice bedlam, but a bedlam all the same.

Balloons float above each cubicle, every few seconds there is a flash from a camera or a semi-serious discussion about whose turn it is to hold the baby. Grandmothers queue to hand out knitted cardigans, new-borns cry from being handled too much and the ward is drowning in baby-grows. Baby-grows with bumble bees and Disney characters and cute little logos: 

“I love my mummy”

“I love my daddy”

“I’m just perfect”

There is just one more baby to check. One more little life to be sent into the world.

I have to fight my way through the chaos, to get to a side room along the corridor.

To anyone who glanced in, the room would appear to be empty. Quiet, clean and still. But lying in the cot, in faded clothes which are worn from too much washing, a new life is waiting for his turn in the world.

There are no balloons here. No one is fighting for the chance to hold him. There is no mother waiting for my words of reassurance. She has left to resume whatever life she had before. Lost in the crowd. I don’t know her reasons, nor is it my place to find out. But it will always be my place to wonder. 

The midwives feed and hold him, but they must smell of uniform and NHS and other people’s families. A different midwife for each bottle. A different voice. A different family. The other mums have wandered in to speak to him, but were quickly drawn away by the pull of their own babies, before he even knew they were there. One mother has left a toy for him in a corner of the cot.

A little, soft, grey elephant who watches over her new charge with solemn, stitched eyes.

There is no one to wait anxiously whilst I listen to the beat of his perfect heart. No one to congratulate. No one has taken his photograph and his first few hours on this earth were never recorded. He lies still whilst I look into his eyes. He makes no objection to being turned or moved and when I examine his hands, tiny fingers curl around mine for comfort.

He passes his baby check with flying colours. He’s perfect. He doesn’t need a baby-grow to tell me this.

The baby reaches into the space above his cot, for a cuddle which will never be there. Little legs kick underneath the borrowed blanket and his eyes dart around the room, trying to make sense of a world which has already rejected him.

The elephant watches.

Someone will come for him. In an office across the town, there is a filing cabinet full of the names of those who wanted him even before he existed. He will be someone’s precious gift. I comfort myself with the knowledge that he will never remember. He will never think back to a ward full of balloons and cameras and excited voices.

I look down at him and say he’s perfect, even though there is no one to tell. I pick up the elephant and hold it in front of his eyes because it’s the only thing here which has any connection to him.

He is too young. These moments will be lost. I know the first memory he makes will be a happy one, yet I am surprised by how difficult it is to leave. I look into the room one last time and the elephant stares back at me, with solemn, stitched eyes.

The elephant and I have an understanding.

All the way down the corridor, I tell myself that it will be fine. This time tomorrow, he will have baby-grows and hand knitted cardigans and a new life all of his own. He will grow up and go to school and make friends and one day he will have his own family and visit this ward with balloons and cameras and excited voices.

He will remember none of this.

But an elephant … an elephant never forgets.

Did They Beat The Drum Slowly?

Over the years, I have acquired huge quantities of what most other people would consider to be junk.

A postcard from my grandparents in 1973, showing an attractive view of the seafront at Bournemouth, several pebbles from the beach at Sandsend (which I selfishly considered to be too beautiful to leave behind) and tucked away in the back of a book, I have the last note my Dad ever wrote to me – about how much food to give the dog and when I needed to put the bin out. 

I have a box full of these things and I can’t bear to part with them. 

They’re a fragile link to happier times, when we had a full set of family members and nothing really mattered for all the right reasons.  When I read my father’s handwriting, I can imagine he has only stepped into the next room and when I look up, he will be standing in front of me and everything will be the way it’s always been. 

Of course, I have memories as well, but I need to read and hold and touch and feel the past in my hands.  To make sure it was really there. 

And I’m frightened of forgetting. 

A postcard, a cinema ticket, a pebble from the beach – seemingly insignificant things which are lying at the back of a drawer or hiding in a coat pocket.  One day we will stumble across them again and realise they are amongst the most precious objects we possess.  A gift from the past. 

And photographs.  Hundreds of them.  Photographs, which were once stuffed back in a Kodak envelope and forgotten about, are examined over and over again … in the hope that they will be generous enough to release another memory or by staring at them for long enough, we will see something we’ve never noticed before.

My Dad used to say that if someone bothers to dust your photograph after you’ve died, then you’ve done rather well for yourself. 

There was an old lady who lived several streets away from here.  Within a few days of her death, a huge skip appeared on the driveway.  Each day when I walked past, I noticed that in addition to the broken furniture and the rolls of carpet, little pieces of the past had begun to appear.  Photographs, letters, treasured ornaments which were once dusted and admired … the last person they mattered to had left this earth and once again, they had become insignificant.

I think this is why I find car boots so fascinating.  Hidden amongst the broken bits of Lego and the soggy paperbacks are items which once had the power to touch someone’s heart, but now find themselves sitting on a trestle table in a wet Sunday market.  Forgotten, lost and worthless.

I once stood looking at one of these trestle tables and a man next to me pointed at one of the items he wanted to buy.  It was a photograph of a soldier from the First World War and, although he was slightly faded and time had stolen some of his spirit, he looked just as a hero should – handsome, courageous and full of hope.  The seller began making idle conversation, as he took his one pound fifty, but the man next to me interrupted him and said:

“I’m not interested in the picture, I only want the frame”

And so the stallholder took the photograph of the old soldier out of the glass casing and threw it away.  The young man in the picture had ceased to mean anything to anyone in this world and there was no one left here who wanted to claim him.

I often wonder what will happen to my box of memories.  To anyone else, they will be an inconvenience – a strange collection of insignificant things which will be thrown on a skip or (if someone is lucky) sold for a few pence at a Sunday market.  And, although it hurts to admit it,  I doubt very much anyone will bother to dust my photograph. 

If anyone is wondering, I rescued the old soldier from a black bin liner on Calverton market.  I paid fifty pence for him.  I have no idea who he is – whether he lies in the Green Fields of France or if he returned to a hero’s welcome and lived to a deliciously old age.  But in the spirit of Eric Bogle, I will always think of him as Willie McBride.  

And he is dusted and he matters. 

Perhaps, long after I’m gone, someone will be kind enough to do the same.

A Really Good Coat of Looking At

Doctors are trained to take a patient history in under twelve minutes. 

From the moment you walk into the consultation room, you have around seven hundred and twenty seconds to get whatever brought you there off your chest.  It sounds a doddle, but believe me, it’s not. 

At medical school, we have bells and buzzers and claxons to train us.  We also have a wonderful selection of fake patients, with text book symptoms and an aversion to chit-chat, who make our lives an awful lot easier. 

Real life patients aren’t quite so obliging.  

Rather selfishly, most of them don’t read medical books – so their symptoms are vague and numerous and confusing.  They also like to talk about the weather and their grandchildren and how the next door neighbour keeps them up all night, playing loud music and arguing with his wife.  If patients were books, they would be an Agatha Christie novel – with a cast of thousands and a clue on every page.  As a doctor, you have twelve minutes to read the book, find the clues and solve the murder mystery.  It isn’t easy.

But it’s the ‘by the ways’ you have to watch out for.

These are the patients who seem to be a God send.  They’re not interested in the weather and if they have over-achieving grandchildren or noisy neighbours, they like to keep it to themselves.  These patients come to the surgery with a sore throat or a backache or a pulled muscle.  Simple, straightforward and clean.  Within eleven and a half minutes, they are tucked up in their coats, heading towards the exit with a prescription folded neatly in their pockets.  Then, just as they are about to leave, when their fingers are actually resting on the door handle, they stop, look back over their shoulders and say:

“By the way …”

And then you realise that the sore throat was just a prologue.  The real story hasn’t even started – and it’s the by the way you really should be reading, because it’s a:

By the way, I think I’ve found a lump in my breast

or

By the way, I’ve been getting a bit of chest pain

or 

By the way, I’ve got a bottle full of paracetamol in my bedside drawer and if someone doesn’t help me, I’m frightened that I’m going to take the whole lot.

These are the stories we need to listen to.

An elderly lady once attended a GP surgery to talk about her blood results.  She was accompanied by her husband, both in their best clothes – because to that generation, going to see their doctor is an occasion for which one is supposed to dress up.  They shuffled into the consultation room, all coats and walking sticks, and took a tantalising amount of time to settle their old bones into the plastic chairs and find somewhere for all their possessions. Three of their twelve minutes had already passed.  At first, I wondered who the patient was.  And then I realised they both were.  They were a team.  The doctor spent a good seven minutes, talking about the lady’s renal function and her haemoglobin and how it was normal for someone of her generation and how he would see her again in three months’ time.  And she replied:

“Potatoes”

We all looked at her curiously and she continued: 

“I can’t stand at the sink anymore to peel the potatoes – I feel too old and tired.”

So the doctor smiled (in the way that doctors sometimes smile at patients) and he spent a further two minutes saying that everything was normal and to make an appointment for three months’ time on her way out.  The claxon had sounded.  The twelve minutes were up.  And so the elderly couple disappeared from the consultation room, with their walking sticks and their untold stories, and a fragment of their independence was left behind on the plastic chairs.

When I was growing up, I always went to my father with problems.  He was the kindest, most patient, most wonderful man I will ever know and he always knew how to fix things – from broken hairdryers to broken hearts.  Whenever I presented him with my latest drama, he would tap his pipe out on the fire grate, lean back in his chair and always say the same thing:

“What every problem needs first, more than anything else, is a really good coat of looking at”

And he was right.  But in a society where we all have internal buzzers and bells and claxons, giving something a really good coat of looking at isn’t usually an option we can take.  As A&E patients change from green to amber to red and GP surgeries fill with people who are anything but patient, those twelve minutes become increasingly precious.  We don’t have time to read the whole book.  This is how the cancer and the overdose and the heart attack are missed and when they are, we all start shouting and screaming and blaming each other.

In the land of twelve minutes, doctors really have to be fast readers, because there are some stories out there which definitely need to be heard.

Brave Faces

In about the third year of medical school, you are taken to one side and taught how to break bad news to patients.  This teaching involves important suggestions, such as:

Ensure there is a box of tissues handy

and

Make sure you give the patient an opportunity to speak.

There’s even a handy mnemonic, just in case you temporarily forget how to be a human being.

I have sat and listened many times as many patients are told that their cancer is going to kill them.  I have heard the consultant fire a warning shot (I’m sorry Mrs Jones, but I have some bad news) and I have witnessed the breath-taking silence which follows these words, as we all wait for the patient to respond. 

You will never hear a silence quite like it. 

When the patient finally speaks, it is always to offer up an opportunity for hope.  They quote their friends and the internet and things they’ve seen in the newspaper.  They tell you stories of people they’ve read about, who have defied the laws of medicine but who never quite made it to the front cover of The Lancet.  Lastly, when the consultant has cruelly shot down each of their sentences with jargon and statistics and test results, they give you their final fragment of hope. 

“They’re always making amazing new discoveries now though, aren’t they?”

They always say this. 

Always.

The consultant then smiles at them patiently and offers information leaflets and an appointment with the palliative care nurse.

It is at this point, the patient is expected to be brave.  It’s in the contract.  If you are told you are going to die, society dictates that you take it on the chin.  It makes it a lot easier for everyone if you don’t make a fuss.  We can then sweep you into a corner of the ward and tell everyone how stoic you’re being.  Doctors like stoic patients, because it makes them feel a little better about losing out to God.

A very experienced consultant once went into one of the side rooms and told a young woman that she was going to die.  The cancer was marching through her body, climbing her spine like a well-trained army and crushing each vertebra on the way to her brain.  There would be no amazing new discoveries for her.  This would be her final Christmas with her family and, although she didn’t know it at the time, she had already lived her last summer on this earth.  The woman in the side room clearly didn’t read the contract.  She wasn’t stoic, she was angry and vengeful and sour.  A few days later, when the woman in the side room continued to snap and cry and criticise the unfairness of it all, the consultant considered her behaviour to be unreasonable.

I’m not entirely sure what constitutes unreasonable behaviour in these circumstances.

If someone told me that I was going to die, that cancer was rushing around my body at full speed, as if it had a very important bus to catch, I rather think I should be unreasonable too.  More than that, I think I should shout and scream and throw furniture, because I didn’t sign the contract either.

We expect cancer patients to sign the contract.  Society pressurises them into it.  The language of cancer is such that patients battle and fight.  We talk about cancer in hushed tones, lowering our voices and speaking very quickly, just in case the cancer hears us and gets big ideas about itself.  Cancer patients raise money for other cancer patients; they smile for the camera and make jokes about losing their hair, so we all feel more comfortable about life and if they are fortunate enough to win their battle, they become a survivor and are paraded around to ensure everyone else remains stoic and reasonable.

I admire these people, I honestly do.  I cannot begin to tell you how humble I feel when I read their stories.  I just worry about the ones who are left.  The ones who didn’t read the fine print. 

There was once an elderly gentleman on the ward, who was edging through the last days of his life.  He had a huge army of healthcare professionals who visited his bedside on a constant circuit – oncologists, urology surgeons, palliative care nurses, dieticians, physiotherapists, pain management specialists – all making sure he was dying the proper way and not letting the side down.  For each one, he brought out his best brave face.  With the little energy he had left, he would smile and nod and talk about making the best of things.  He knew he was going to die.  He just wasn’t allowed to do it in peace.

When they had all gone, I went over to talk to him and asked him how he was feeling.  He told me to draw the curtains and when I had, he took my hand and spoke very quietly, just in case the rest of the ward could hear.  He said:

“Jo, I’m scared.” 

And he was ashamed.

They don’t teach you how to answer that at medical school.  There’s no handy mnemonic or useful worksheet.  Along with our degree certificate and a subscription to the BMJ, we also sign an unspoken contract to be distant and dispassionate.  As doctors, we are not taught how to comfort or care or cry with someone who is afraid of dying.

I think perhaps we should be.

Two Thousand Fried Sardines

When I was little, my mother used to leave me at the library whilst she went shopping.  I’m not entirely sure what today’s troubled society would make of this but, along with eating cake mixture and Test Card F, it never caused me any serious harm.

It was a wise decision on my mother’s behalf.  I needed at least an hour to decide who was coming home with me that week, because the choice would shape my thoughts and actions for the next seven days.  I also had to make sure that I renewed Little Women.  I did this religiously, every week, because Jo, Beth, Meg and Amy were my friends and the idea of them living with someone else (even temporarily) was unthinkable.  I also had to allow time to be told off by the librarians, who would viciously stamp my card and mumble under their breath about overdue fines and good parenting. 

They didn’t understand that I failed to return my books, not because I was slapdash or selfish, but because I couldn’t bear to let them go.  They were my friends.  When I was worried or scared, I would turn to Aslan for advice, I searched the riverbank endlessly for a glimpse of Mr Toad and when I played in the garden, I was never alone – I had Jo and Meg to keep me company.  Hidden amongst the highly polished shelves of my local library were new friendships and fresh adventures, in lands I would never visit and with people who would stay with me forever.

The library is far less stern now.  It has pots of coffee and internet stations and their automatic doors are open far more often.  When I was a child, library opening days were my favourite days of the week – Tuesday, Thursday, Friday and Saturday.  Two Thousand Fried Sardines, should I ever be foolish enough to forget.  Now, instead of brown cardboard tickets, there are fancy swipe cards and convenient online renewals … my little library has changed beyond recognition, but the adventures are still hidden away on the book shelves and Aslan sits patiently waiting for a new generation of children to find him.

If the government have their way, he may never be found.  The chances of bumping into Ratty and Mole at your local car boot are pretty remote and I have never seen Anne of Green Gables wandering around my local Oxfam.  My heart aches for the children who will be deprived of their company, the ones who will never peer curiously into the back of the wardrobe or be tempted to cut off their hair to add to their pocket money. 

We are denying them some of the most important friendships they will ever make.

Holding On

Casualty has a lot to answer for. 

It may have inspired a whole generation to step into Charlie Fairhead’s scrubs, but when it comes to death and dying, it’s a wee bit off the mark.  People do not slip away quietly, having said their last goodbyes and made tearful amends with their loved ones.  Death isn’t calm and tranquil.  It’s often messy, desperate and chaotic.  We tell ourselves (and our friends who read the local newspaper) that people passed away peacefully, but this is just a gratuitous phrase, mumbled alongside things to do with a good innings and people not really suffering.  Something we say when we need to make ourselves feel better, because the human race isn’t particularly skilled at dealing with death.

A little while ago, I sat with a patient whilst they died.  A few hours earlier, on the ward round, she had been told by the consultant and his team that they could do nothing else for her and they were just going to concentrate on just making her comfortable.  She looked up at them and said thank you.  She actually said thank you.  Because when you’re ninety-something years old and lying there in your nightdress, when there are five men in suits standing over you, wielding their stethoscopes and public school educations, there is probably very little else you can think of to say.  Then the five men in suits moved onto the next patient and left her to wait for God in a brightly coloured side-room, surrounded by puzzle magazines and packets of Polo mints and all the other debris you collect when you’re in hospital for a very long time. 

God didn’t take very long.  In the morning, she had told me all about her sons and her bingo and her addiction to gingerbread.  When I went to see her a few hours later, she had stopped talking and just gazed into the distance, past the open door and the nurses’ station to somewhere my eyes couldn’t see.  So I sat and held her hand.  I told her about my day and the sunshine outside and what I’d had for my lunch.  I told her anything I could think of, just in case she could still hear my voice and every now and then I had to turn away to adjust the curtains just in case she knew I was crying.

I wondered when it was that the world started to slip away from her.  When the open door and the nurses’ station and the rest of the ward moved beyond the horizon … and I wondered what had replaced them.  Eventually, her eyes grew milky and she began struggling to force air into her tired lungs.  And then ninety-something Christmases and ninety-something birthdays left this world and she was gone from me.  I sat there, amongst the polo mints and puzzle magazines, with books she would never finish reading and photographs of great-grandchildren she would never see grow up and I cried for a lady I didn’t even know.

I still held onto her hand for a very long time.  I knew that when I let go, she would be swallowed by the hospital machinery.  She would be numbered and tagged and swept away into another part of the building and I didn’t want that to happen.  After ninety-something years, she deserved a few more minutes in the room with the photographs.  It was sitting there, trying to reassure myself with gratuitous phrases, when I first noticed her other hand, cold and lifeless on the top of the bed … and I saw that her fingers were curled around the top sheet and she was gripping it so tightly, the material had gathered into folds within her fist. 

And then I realised how much she’d wanted to stay. 

Even after all this time she wanted to hold on to this world.  Because despite the consultant and the men in suits and the world in general thinking that you’d had a good innings – you, yourself, might have different ideas.

And I suspect that, even after ninety-something years, you would like just a little more time.

Just West of Dagenham

There is a patient on the ward who has lost their mind. 

This is a quaint turn of phrase which implies an act of carelessness on their behalf.  It suggests they weren’t concentrating properly, became distracted and somehow mislaid it.  Like a set of house keys or a Jack Russell Terrier.  It also suggests that it was their own fault.  It suggests that we are all responsible for our own sanity and, if we should be foolish enough to shirk that responsibility, well … to be honest, we deserve all that we get.

Of course, we don’t use that phrase.  Not to their face.  We say they have a “deficit”.  A good, solid medical word, you would think.  But despite its clinical acceptability, it too means failure.  In no other specialty would you be allowed to label a patient a failure.  We don’t even have renal failure anymore, we have “kidney injury” and heaven forbid you should describe a woman in labour as having “failed to progress”.  We live in a society where our bodies are not allowed to fail.  Our bodies become injured, distressed or neglected.  They simply do not fail.  Our minds, however, are a different matter.

There are many different ways of determining whether someone has lost their mind.  In medicine, everything has to be quantified.  If it can’t be scored out of a hundred and expressed as a percentage, then it really isn’t worth knowing about.  If you want to find out whether you’re depressed, psychotic or demented then there’s a test out there for you.  Part of the Alzheimer’s test involves asking patients to count backwards from 100 in sevens.  It always makes me smile that, for the benefit of the examiner, the answers are written at the side of the page.

Once diagnosed, mental illness is a bag for life.  Our minds govern our defining status.  We may be the woman with bowel cancer or the man with an enlarged prostate … but if our minds start messing us about, we become schizophrenic or manic depressive.  We are what we think. 

So if someone finds themselves just west of Dagenham (Barking) it would appear they only have themselves to blame.  They will be bounced around the hospital from service to service, until someone has the good grace to give them a psych referral.  Psychiatry will then either fill them with drugs until they forget who they are or introduce them to the joys of woodwork – in the vague hope that it will one day, miraculously, restore their sanity.

But to their face, we will say they have a deficit.

I think I prefer “lost their mind”, because it suggests there is a possibility, however slim, that they may find it again.