by Bev Thomas
I stood at the back door, a hand shielding the sun from my eyes, gazing out over the small grassy slope that the twins used to roll down as children. Tom was at the back of the garden, up a ladder, holding the bird box against the silver birch. We’d already missed the nesting season, as David had promised, and failed, to put it up for the spring. Tom said he’d do it now. ‘You never know,’ he laughed, ‘you might get a few latecomers. Here?’ he called out. ‘Then you’ll be able to see it from the kitchen—?’
‘Yep,’ I called back, ‘that’s great.’
He placed the bird box on the branch and reached for a nail from his pocket, then gripped it between his teeth as he picked up the hammer.
The bird box had been his Christmas gift to me.
Tom’s gift giving was often random, depending on his fluctuating feelings about the evils of consumerism. That year, in spite of the fact Tom was so influenced by that book about Christopher McCandless, he surprised us all when he handed out wrapped presents.
My gift was in paper patterned with small silver angels.
‘Thank you so much! Fantastic,’ I said, staring down at the parcel in my lap.
On the other side of the room, Carolyn bristled at my exuberance.
‘It’s not just any old bird box,’ he said, when I opened it up and thanked him. ‘It’s fitted with a camera.’ He leant in to show me. ‘So when a bird lays eggs, you can connect it up and watch the live feed on the telly.’
‘Tom,’ I said, ‘that’s lovely. So thoughtful.’
He sat forwards in his chair, overexcited. ‘It’ll be like the Big Brother house,’ he said, ‘for birds.’
We all laughed. Even Carolyn.
*
A year and a half on, the garden has been neglected. The box is now hidden under thick dense foliage. You’d have to be a ferret to fight your way into that hole.
There had been a bird the spring after Tom disappeared. A blackbird. I switched on the camera every day and spent each evening watching the mother carefully fashion a nest out of twigs and fluff and leaves. There were four speckled eggs, each a pale turquoise. As the time came near, I would rush home from work and spend hours on the sofa sitting by those jetblack feathers in a state of nervous expectancy. While I knew she couldn’t see me, it felt like the two of us were watching over each other. As I sat still on the sofa, I felt safe under the small orange bead of her eye. Naïvely, I felt her arrival might somehow trigger Tom’s return.
When the babies hatched, the nest was a writhing frenzy of movement. I saw them only briefly, before I had to leave for work. They were grey and helpless and blindly clamouring for food, as the mother patiently fed their open mouths one by one.
I remember the day was unseasonably hot for March and the therapy rooms were stuffy and airless, even with windows pushed wide open. I felt a pressing eagerness all day, and when a patient cancelled her afternoon appointment, I left work early.
I switched on the television, the screen was blank. There was nothing to see. I checked the connection, fiddled with the remote. Nothing. Just the dark brown of the inside of the box. The blackbird had gone, and as I zoomed in closer, I saw the lifeless bodies of her babies strewn around the nest like scraps of leftover meat.
Three
On Monday morning we have the departmental case discussion, and it’s my turn to present. It’s obvious who I should bring for discussion. Only three days earlier, I’d been explaining the format to Stephanie, our new trainee. ‘Patients we find challenging,’ I said, ‘a space to explore the unconscious, and how it might affect the work.’
She nodded enthusiastically, the cut of her bob slicing neatly back and forth.
I mentioned ‘projection of emotion’, and made a point of talking about transference and counter-transference. I deliberately used terminology that I knew would be unfamiliar to her. But in the space where I was expecting questions, requests for clarification, or at the very least confusion, there was nothing.
‘Every fortnight?’ she wanted to know, as she tapped the date into the calendar of her phone.
Stephanie had made herself known to the department well before her start date. In the two weeks before, she was either emailing or phoning on a daily basis. For the most part, they were petty admin enquiries: a parking permit, library membership and requests for forms she didn’t need. The ones that came my way included a query about attending a conference on trauma and attachment theory, and a request for ‘relevant literature’ to read before she started. ‘Seems very keen!’ Paula observed in her forwarding email.
When I read her student report, I saw a high achiever; a first from Oxford and (just like me, many years ago) the offer of a place on a Clinical Psychology training course after only a year of work experience. But I also saw someone whose previous three placements had been in Cognitive Behaviour Therapy. She had no experience of our therapeutic approach and, reading her personal statement, it was hard to fathom her reason for choosing her specialist placement here with us. As I took in the neat symmetrical bob, the manicured nails, I realised Paula had been wrong. It was anxiety, not eagerness, that was her motivator.
Towards the end of our first meeting, I’d tried to find a way in by asking about the papers.
‘They were good,’ she said.
‘What did you make of Melanie Klein?’ I persevered, knowing how most students struggle with the density of her writing.
‘Really interesting,’ she nodded blandly. ‘Thanks very much for sending them.’
And that’s when I understood my irritation. It wasn’t the fact that she had gaps in her understanding and theory. Nor was it her avoidance, or capacity for denial. It was the fact that she thought her performance was credible. That somehow, she believed she had fooled me.
As I’m walking to the group room, I run through the possible case options in my head. I know I can’t talk about Dan. Bringing Dan would mean talking about Tom – and without Tom, there wasn’t much to say about Dan. So instead, I pick another patient who is challenging in a very different way.
Most of the staff are here, except for Stan and Maggie, who are representing the team at Alfie’s funeral. The room is full, and as well as Stephanie, we have a medical student for the week. He’s busy on his phone, and wearing a disconcertingly bright red tie. It’s easy to spot the budding male surgeons: the jazzy accessories, the manufactured busyness, all preludes to viewing psychological thinking in much the same way they might a workshop on crystal healing.
‘Hayley Rappley,’ I say, and as I mention her name, there’s an air of anticipation. Excitement even. People draw breath, lean forwards.
I took Hayley on as a new referral a month ago. Looking back to that allocation meeting, I was already overloaded, I didn’t need another patient. Especially one like that. But when I heard the details of the case, I didn’t hesitate. Maggie was chairing that day and handed her straight over. There was relief in the room. After my work with Matt Johnson, all the complex young ones come my way. I can’t resist them. That pull to dive in. To help. To make things better.
‘Most people are familiar with the tragic circumstances surrounding this case,’ I continue as I open my file, and then look up. ‘I have seen her three times, and as you know, she agreed she’d come for the standard six sessions.’ The group nod, recalling the unusual set-up between her and her father.
‘No sign of flashbacks … intrusive thoughts,’ I say, flicking through my notes, ‘and I’m still of the mind that she needs something – but not necessarily our service …’
‘I don’t understand,’ Stephanie says. ‘Why wouldn’t she?’
‘Because having a traumatic experience doesn’t necessarily mean a person has a traumatised response. They might be struggling, finding it extremely difficult to cope – but they may not have PTSD symptoms. And I’m not sure Hayley has,’ I explain.
I tell them she’s been turning up. ‘But she’s ticking off the sessions like items on a shopping list. On week two, she
spent much of the session in silence, staring out of the window. I am very aware of the arrangement – and how it’s affecting the work. Her promising her father she’ll come. His expectations of me. I feel pressurised, and also aware that this is fuelling my efforts to engage her.’
At the end of the second session, I’d asked her to bring in something that reminded her of her mother. ‘It’s not something I would normally do,’ I explain, ‘though as I’ve outlined, this was a slightly odd situation.’
I tell the group that when I collected her from the waiting room for her last session, she was wearing a tight red dress, high heels and a layer of heavy make-up.
‘She teetered into the room – then says ta-da! waving her hands down her body, then looked at me, face all angry and tight. “The thing that reminds me of my mother?” she said. “You asked me to bring something. Well, here it is. I’m wearing it!”
‘As it transpires,’ I continue, looking around at the group, ‘the red dress was the focus of the argument that Hayley and her mother were having at the time of the accident. I don’t know the details. She still hasn’t talked about it. In fact, she hasn’t talked about anything much at all.’
I’m about to continue, when Jamie cuts in. That gentle lilting Scottish accent. ‘Ruth,’ he says, leaning forwards. ‘Earlier, you said you felt under pressure to engage her …’ He pauses. ‘I’m wondering what it would be like if you didn’t?’ he asks. He strokes a finger over the bridge of his nose as he speaks. Naturally shy, it’s a habit he’s developed when he speaks in a public forum.
All eyes turn from Jamie to me, as they wait for my response.
Jamie is good. He should be. I was his supervisor. He’s doing exactly what I’d do if the roles were reversed. He knows I’m playing it safe, focusing on the details of the case, keeping the spotlight away from me. He’s fishing, while I’m doing my best to wriggle off the hook.
The room waits expectantly. Stephanie is sitting next to me, poised with her pen. I feel a prickle of heat at the back of my neck. I want them to stop looking at me.
‘If I don’t engage her?’ I repeat slowly. ‘Then I fear she will be lost. Lost and angry. Lots of fifteen-year-old girls feel lost and angry.’ I hesitate. ‘Not many have witnessed the death of their mother.’
‘In the absence of her real mother,’ Jamie observes, ‘you have to help her internalise the “good mother” that she knew. Even though she is no longer here.’
For the benefit of Stephanie and the student, he explains a little about Klein and the ‘good mother’ and how her ideas were later developed by Winnicott. Stephanie scribbles furiously in her notebook. The medical student is glancing down at his watch.
Jamie looks back at me.
I nod. ‘At the moment,’ I say, ‘her mother and I are very much the “bad objects” – her real mother because she has abandoned her. Me, simply because I am not her mother and because I’m getting her to talk about her loss. It will be difficult for her to see me in any other way.’
‘Of course,’ he nods.
‘Anger is safer,’ I say, ‘easier. Much less painful.’
‘And what about you?’ asks Jamie, switching on the spotlight once again. ‘You chose to bring her today. There must be a strong maternal pull? Where are you in all this?’
I pause for a moment.
‘What do I feel?’ I close my eyes briefly. ‘I feel – I feel a tremendous weight of responsibility.’ I’m shocked as I notice my eyes welling up. Quickly, I look down, to reach for my file. ‘I feel I need to get this right,’ I say, ‘to find a way to help her.’
‘So, perhaps that gives us some insight into what Hayley might be feeling,’ Jamie offers gently, ‘the tremendous weight of responsibility.’
At the end of the case discussion, there’s a slot to review the new referrals. I run through the list and when I mention Helen Cassidy, Eve holds her hand up. ‘She’s been allocated to me. Please can I hand her over to someone else?’ She hesitates. ‘I hadn’t realised she was pregnant.’
People shift in their seats.
I flush. I can’t believe I’ve referred a pregnant client to a member of staff who’s just had a miscarriage.
‘I’m so sorry —’
‘It’s OK,’ she says quickly, ‘not your fault. The GP had left it out of the letter. Admin error. It’s fine. Any takers?’
After we allocate the case, I look at the GP letter.
‘Hasn’t this happened before,’ I ask, ‘same GP?’ There are nods around the room. I shake my head. ‘We rely on accurate information from our GPs. Often our only source of information. To say nothing of the fact that this particular patient will need linking in with Perinatal Services.’ I take the file. ‘I’ll follow it up.’
After we move on, this is the moment for me to offer up Dan Griffin. A patient who’s vulnerable and estranged from his mother. A patient who’s undoubtedly got attachment issues.
A patient who looks like my son.
‘Any other business?’ I say, looking round.
Several shakes of the head. Then Anna speaks up. ‘A quick feedback. ‘Andrew Doornan,’ she smiles, ‘he’s gone back to work.’
There are nods. Murmurs of appreciation.
‘Well done,’ I say. ‘Great work. Anything else?’ I scan the room.
Eve mentions Matt Johnson’s latest blog. ‘Might be useful for our students to read a patient’s perspective?’ and she nods around the room.
It is a good learning opportunity, but I wonder, too, if it’s an attempt to appease me, after exposing my inadvertently clumsy referral.
‘Good idea. It’s certainly worth reading. Matt’s an A & E doctor,’ I say, making a point of looking over at the medical student.
Stephanie makes a note in her book.
‘That’s everything?’ I glance around the room. ‘OK. Let’s finish there for today.’
*
In the week between Dan’s first and second appointment, I think of him often. Alongside this preoccupation grows the knowledge that I must call Robert. Supervision is something I’ve been giving and receiving for the last twenty-five years. I know what it’s for. Robert has been my supervisor for most of my career and while I have picked up the receiver several times over the week, something has stopped me making the call. I imagine it’s because I know exactly what he will tell me to do. He will tell me I must stop seeing Dan, that the issues with my own son will get in the way of our work together. And I know this is precisely the reason that I don’t pick up the phone.
Instead, I tell myself a different version of the story. I tell myself it’s all in my head. That the likeness to my son is something I have conjured up, and that the whole episode has taken on a dreamlike quality, one which I will wake from when I see Dan again. But when he arrives on that Friday afternoon, a week to the day of his first appointment, I’m not sure whether to be disappointed or relieved that he looks just as I remembered.
He comes in wearing a black hoodie pulled up over his head. He drops the hood when he sits down, revealing hair that is greasy and lank.
‘Sorry,’ he says, trying to make a joke of it, ‘I know I look terrible.’ He slumps back into the chair. There are dark circles around his eyes. His skin is grey, sallow.
‘Dead ringer for Gollum,’ he says.
I note the jokey banter. A lightness to direct me away from his distress. To keep me at a distance.
‘I saw the GP. She gave me tablets. To help me sleep.’
‘And are they?’
He shakes his head.
The mention of the GP reminds me I haven’t yet received his records from the Hackney practice. I make a mark on my notes and circle it twice as a reminder.
The bruise on his cheek is a now a faded yellow, his hand still covered by the grubby frayed bandage. I have the urge to move closer, to reach out and encase his hand in my own. To inspect the wound, and find a crisp white bandage to wind gently around his fingers.
‘I want to tell you
what happened in the park,’ he says.
Before I have the chance to answer, he launches into the story.
‘It was early evening, still light,’ he says, ‘I was chatting to my mate on the phone, when three of them appeared out of nowhere, wearing beanie hats. They dragged me into the trees.’
He is talking quietly and matter-of-factly, staring down at the patch of carpet between us as he speaks.
‘At first, I thought they wanted my phone. So, I’m all ready – to hand it over.’
He scratches at the side of his face.
‘They just laughed. One of them took it and turned it over in his fingers, then stamped on it. We don’t want your phone, he said. So now, I’m getting worried. One guy, who I never actually saw at all, was holding me from behind, around my neck. All I could see was the tattoo of a snake on his forearm, curling around his fingers. He was sort of pulling me further into the wooded area, behind the tennis courts.’
I nod for him to continue.
‘The one with his arm round my neck was still laughing. Jim, he thought we wanted his phone. Shall we tell him? Then he pressed his mouth close up against my ear. We don’t want your phone, he said very quietly, we want you. We want a piece of you. And then he punched me in the stomach.’