In Two Minds

by Gordon Parker

  Martin continued. ‘I respect that you find it somewhat unsettling.’ He then offered his final disclosure. ‘I’ve self-reported to the Medical Board and they will judge whether there is any incapacity or any need to restrict my practice. If any of you wish to know any more then I’d suggest we meet one on one, and I’ll go through your questions. Otherwise I’m planning to start back on Monday. Thanks for giving me the opportunity to speak about all of this.’

  Martin suspected he had finished rather lamely as there was no clapping. That, however, would have been condescending. Most of the doctors came up to him and gave him a smile or shook his hand. Tompson and another doctor remained seated and in close discussion.

  Dave walked with him and the two went to Martin’s room. ‘How do you think it went?’ Dave asked.

  ‘Hard for me to judge. Probably best to give your impression.’

  ‘You went as far as you needed to go, Martin. I thought you were sufficiently disclosive to reassure them. Brett is still diffident about you. He’s heard something more, I believe.’

  ‘You think Bella has sown some poison?’

  ‘Doubt it as he would have raised it. I’m sure he’ll settle when you’re back. You know the irony of all this, Sunny?’

  ‘Tell me. I’m feeling in an irony-free zone at the moment.’

  ‘One in ten doctors, perhaps more, are on antidepressants in this country. An extra percentage are on mood stabilisers. Add a huge number taking anxiolytics and sleeping tablets. Throw in illicit drug problems. Add alcohol excess to the mix. And yet you’ve needed to justify yourself and tell everyone you’re receiving treatment. The irony is that we two set this review process up in our practice. There would be no other practice in Sydney that would require a practitioner to account for himself to his colleagues.’

  Martin shrugged. ‘We reap what we sow. I guess it gives another definition to peer review.’ He paused before adding, ‘Thanks again, Dave. You should get back to work. I’ll just sit here for a few minutes, suck in the ambience, and get myself ready for Monday.’

  ‘Cheers, mate.’

  Shortly after Dave left, there was a knock at the door. It was Wendy, the practice manager. She was carrying some flowers and a bottle of red wine.

  ‘Martin. We are all so delighted that you’ll be back next week. We’ve missed you so much. The girls have put in for some flowers for Sarah and some wine for both of you.’

  Martin appreciated the delicacy of the last few words. He blinked rapidly. ‘Wendy, that is so generous.’ He risked tearing up, especially when Wendy gave him a brief hug.

  ‘I know this is an unfair thing to say, Martin, but you are our favourite doctor.’ She smiled and left the room before he said anything more. Although it would not have been appropriate to mention that he was off wine while taking his antidepressants.

  He drove home and took Captain for a long walk, reviewing the day.

  Marshall had impressed him as a psychiatrist. He had brought considerable logic to the diagnostic process and there was no doubt he was adroit in handling the medication changes and reassuringly supportive in advising him how to handle the Medical Board. But he had not advised him as to how best to handle all the collateral damage. It was as if he assumed Martin could work out for himself how to re-establish his relationships with Sarah and colleagues. As if he assumed Martin was old enough to stand on his own two feet. And then Martin realised that it actually was up to him. That, in becoming a patient, he had already developed a level of dependency on his doctor, anxious to receive his judgments, deferring to him and wanting to be guided at every step. In essence, he had sought to be cossetted. He had always cared for his patients but now he appreciated that there might be risks in caring too much. Care that curdled into overprotection prevented patients from coming to their own decisions and building resilience. Martin shook his head.

  A DARK AND STORMY NEXT NIGHT

  Martin and Sarah were lying in bed together when Martin heard the door open and saw a shadowy figure. He turned the bedside light on and both he and Sarah sat upright immediately. It was Bella. She pulled up a chair and sat at the end of their bed.

  Her voice was flat and she spoke slowly. ‘I guess you’ve been wondering how all this might end.’

  Sarah grabbed Martin’s hand. ‘Well,’ said Bell, ‘we have two possible endings and it’s your choice, Martin.’ She raised her right hand and they could both see a small handgun. ‘I’m going to kill one of you and it’s Martin’s choice only. Usually, in such scenarios, people have ten seconds, but that’s too quick. Not enough time to scare you shitless. You have three minutes starting now. Approximately, I should add, as I’m not going to risk looking at my watch. I am not going to take my eyes off either of you.’

  Martin pushed Sarah down flat on the bed. ‘The choice is easy, Bella. I created this whole disaster. You shoot me.’ He climbed out of bed and headed directly towards Bella, who was now alternately crying and laughing. There was a loud explosive sound.

  Martin woke up suddenly and alone. Now hearing a thunderclap and aware of rain storming down. A nightmare, and one that captured his ruminations over the last three months.

  His relationship with Sarah continued to be problematic. They talked, but mainly about banal domestic or work issues, each aware that they were talking simply to fill the void in their coexistence.

  Martin wondered how he might atone for his infidelity even if it did not lead completely to a reconciliation. As he lay in his own bed, now wide awake from the nightmare, he mused about the richness of the dream work. The wish fulfilment component of Sarah and him being together again, the threat ever posed by Bella and the representation of his manifest wish for expiation. But there was also the latent meaning. That he was prepared to die. Was this simply some romanticised image? Or did it quantify how far he was prepared to go to atone for his actions and regain Sarah’s respect? Or might it mean that he now viewed life as worthless? Or could it be that his depression was returning, and the nightmare was an early warning? Or, perhaps most likely, was the nightmare some compilation and condensation of those and multiple other determinants?

  He eased out of bed, put his ear next to Sarah’s bedroom door and, hearing only her slow breathing, went to the kitchen, made himself tea, sat near the window to watch the sun come up and reflected on the few last months.

  Bella had continued to intrude into his life. Occasionally, the secretaries and even the doctors had calls from her. She never gave her name to any of them and most had observed that ‘the woman who screamed down the phone’ was clearly intoxicated. Dave told Martin that he would handle the scenario, and simply informed the staff that Martin was being stalked by a woman who had an alcohol problem. One of the doctors had suggested that she must have erotomania. A collective interpretation was soon consolidated without any contrivance by Dave that the woman with erotomania or, as one secretary pronounced it ‘rotten mania’, was the cause of the graffiti some weeks back.

  Once, or perhaps twice, Martin thought he saw her Mercedes SLK following him but he continued driving without any increase in speed. And once, when he walked into Marshall’s waiting room, he found Bella waiting there.

  ‘What a coincidence,’ she said with a bright smile. She was dressed beautifully and her eyes were radiantly bright. Martin responded defensively.

  ‘I’m surprised to see you here, Bella.’

  ‘I have an appointment after you with Professor Marshall.’

  Martin contrived to show no reaction. ‘How are things?’

  ‘I’ve left the agency. I’m now advising a politician. I’ll tell you about it if you take me out for a drink.’

  Martin spoke softly but firmly. ‘Bella, whatever it was is all over.’

  Bella immediately raised her voice, almost shouting back at him. ‘It’s not over. I know you’re going before the Medical Board and I’m going to have you sent to Struckoffistan! You will never be able to practise medicine again.’ She slammed a magazine on
the table and hurried to the bathroom. Martin sat pensively for a few minutes before Marshall opened his door.

  ‘Would you like to come in?’

  ‘I’d be very pleased.’

  Marshall looked amused. ‘I’m not sure whether that’s a good or a bad sign.’

  Martin chose not to raise his concern about Bella also being a patient as it would put Marshall into an invidious conflict of interest situation. Marshall went straight to his agenda, effectively a cost-benefit analysis. How was Martin’s mood? How was he tolerating the medication? Any side-effects? He gave an account of his response to the Medical Board and suggested that things should proceed positively. He asked about Martin’s relationship with Sarah.

  ‘She still doesn’t entirely trust me. She still judges it possible that the manic episode unleashed latent impulses, which of course challenges my integrity.’

  Marshall responded cautiously. ‘Sometimes manic behaviours are an extension of the personality. But once they get to a certain level of severity, many people in manic states behave in ways that seem completely foreign to their personality, both to them and us. I say “seem” because how the hell do we really know whether manic behaviour is completely independent of personality or unleached latent needs. Or both. And the same holds for psychotic depressive states.’

  Martin thought of his father. Surely his father had never had any underlying wish to kill Martin? It had to be entirely related to his mood. But he gave Marshall another example, of a woman he had interviewed during his psychiatry term at medical school. She was, according to all who knew her, a loving, kind and gentle woman. After the birth of her third child she had developed a postnatal psychosis, believing that she and her children had no future in a bleak world. While in that depressed state, she had killed all three children, believing she was saving them. Martin learned later that her mood had responded well to treatment but, after release from hospital – and in a rational mood state – she had killed herself as a consequence of recognising the enormity of her actions.

  Marshall observed quietly, ‘Tragic. A rational irrational decision.’

  Martin spoke earnestly. ‘Surely this illustrates that during psychotic depressive and manic states people do things that are completely independent of their personality and entirely mood related?’

  ‘It certainly supports it but I suspect that the two explanations are not always mutually exclusive. How to apportion their contribution, especially as each might operate differently at different stages of the mood state? And vary across individuals. So buggered if I know and I would be worried if anyone else thought they could.’

  Martin responded even more seriously. ‘But you do accept that manic behaviours can be unrelated to the individual’s personality?’

  ‘Martin, I read you. You seek an explanation that supports your own judgment of yourself and the one you wish Sarah to subscribe to. That your behaviours were quite uncharacteristic. It fits with your own judgment about yourself – and one that I share – that you are a man of integrity. And, as an explanation, it effectively exonerates you. Lets you off the hook in terms of your own judgment and in Sarah’s eyes. But can I say there was no predisposition to some of the behaviours? No, as I indicated a few minutes ago. Can you? But do you wish to pursue such reflections? It could drive you crazy.’

  And while Marshall was talking, Martin recognised that, in the early phases of the mania, he could have pressed the abort button. But he had chosen not to do so. He had been aware that the ascent of the high would take him to a new world and almost certainly prevent him from going back to an old world, one of longstanding smouldering grief over the family deaths, of the inability to be a father and, his private concern, of being a Goody Two-Shoes. And a worse concern – that his relationship with Sarah was simply cosy. He had been prepared to spring off the high board, not knowing whether the pool was full or empty but feeling invincible. Just as he had got close to committing suicide when depressed, he knew his behaviours during the manic high risked him committing career and marital self-destruction. But he had chosen to jump. He remembered the AA maxim – We’re only as sick as our secrets. He had hidden and denied that explanation, and he knew he was condemned to continue to do so.

  He spoke slowly to Marshall, offering a superficial summary. ‘The problem, Saxon, is that I’m not sure now that I do know myself.’

  Marshall smiled. ‘Martin. This comment is a bit flippant but I’ll say it anyway. You’ve embarked on your own Homeric odyssey. It’s a self-reflective journey you may wish to continue but, as I’ve indicated, you may torture yourself in the process. It’s been said many times before. Bad things happen to good people. Your self-criticism speaks to your high moral values. But the examined life can be unforgiving.’

  Martin appeared puzzled. ‘The opposite of what I’d expect a psychiatrist to say.’

  Marshall responded quite seriously. ‘I’m simply suggesting you try to stop doubting yourself and move onto another track. That you don’t continue on this Via Dolorosa.’

  Martin wondered whether he simply viewed such issues as unresolvable or that he thought Martin was being neurotic. Instead of asking, Martin said, ‘Thanks, Saxon. When would you like to review things?’

  ‘Say, two weeks. Book earlier if there’s a problem.’

  ‘Thanks. I hope you get home early tonight.’

  ‘Should do. You’re my last patient for the day.’

  Martin walked out to the waiting room. He scanned it quickly. The room was empty. Bella had vanished.

  When he arrived home there was a letter on the table in the entrance hall, with his name and address typed in large font. It contained a single sheet with the photos of seven men under the title Some men in my life. He was not one of the seven.

  Martin decided Bella was playing with his mind. Like the Sherlock Holmes story about the dog that didn’t bark, she was teasing and appealing to him but, by excluding him from the list, perhaps seeking to activate any competitive streak that he had. Martin put the sheet on the dining room table. It was important that he told Sarah that night. He had to show complete openness.

  ON REPORT

  The envelope was marked ‘Private and Confidential’ from The Medical Council of NSW, and contained three stapled communications. The Review Interview Report named Martin and the panel members and gave a brief background, noting that Dr Homer is a 47-year-old general practitioner who lives at West Turramurra and that he had self-notified the Board about his mood disorder three months earlier. It detailed his medical experience, the family history of depression, the possible suicide of his father, and the development of his severe depressive illness followed by a manic episode requiring admission to a psychiatric unit for a week. It provided excerpts from two reports sought by the Board, one from Professor Saxon Marshall (Dr Homer’s managing psychiatrist) and the other from an independent psychiatrist nominated by the Board. Both psychiatrists traced the phases of his illness. Professor Marshall had concluded that Martin had a unipolar melancholic depressive disorder on the basis that his hypo/manic states had emerged following a too rapid escalation in his tricyclic antidepressant medication, had settled very promptly, and as his mood had remained stable on a moderate tricyclic dose and after his antipsychotic medication and mood stabiliser had been progressively ceased. As a consequence, Dr Homer could be expected to remain well, subject to remaining on antidepressant medication for several years at least. The second psychiatrist diagnosed Martin as having a bipolar disorder, but was not able to decide whether it was a bipolar I or bipolar II condition, and opined that further elevated mood states might be anticipated if he was not maintained on a mood stabiliser. Both reported that he evidenced no mood disturbance at their assessment, and that his cognitive functioning and judgment appeared completely intact.

  The Board reported on their interview and the assessment made by the Panel members. They noted that Martin had attended promptly. That he was alert, cooperative and pleasant. They specified his p
ractice load both over the years and currently, noted his commitment to managing the practice and to continuing medical education and listed written letters of support from two of his colleagues in his practice. They judged that there was no need for any neuropsychology testing or other reports. They did not view his mood condition as currently compromising his functioning as a medical practitioner.

  They detailed how he had initially treated himself with antidepressant medication and that his regime with that medication had possibly led to his manic state. They noted that the issue of self-medication had been advanced by the Board being informally notified that Martin had engaged in a morphine habit during and perhaps preceding his mood episode and that both morphine ampoules and several needles had been found in his room in the psychiatric hospital. They had requested a report from the psychiatry superintendent who had responded in relation to the hospital investigations and the police report (Appended). The police report stated that Martin’s clothes and medical bag had been searched after he had been arrested for speeding and that a complete record of his possessions had been drawn up. It was noted that his medical bag was lacking three morphine ampoules from his own written inventory in the pocket of the same bag. The police concluded that, whether the ampoules found in his room were the missing ones or not, it would not have been possible for him to have secreted them on his person as he had been searched on admission and had no leave from the ward prior to discharge. They considered that either another ward patient had put the morphine in his room or it had been brought by one of his two visitors. They had interviewed the two nominated by Martin, and viewed any involvement by Mrs Homer as highly unlikely. The other, a Miss Donna, had not been able to give any reasonable explanation as to why she was visiting the hospital and Dr Homer in particular. She had, however, vilified Dr Homer throughout the interview without providing any specific concerns. Her companion, Jameson Britton, a retired barrister, had indicated to the police that they should ignore her emotional statements and had tried to terminate the interview on several occasions. The police report refrained from any speculation and concluded that no charges could be laid against any individual.