It was the man from the Ministry who put me wise. He came at the end of the month and accused me of over-prescribing. Since I regarded it as a point of honour not to burden the poor taxpayer unnecessarily when prescribing drugs for the patients I responded with righteous indignation at his accusation and assured him that were he to refer to my past record he would find me one of the most conservative prescribers in the district, preferring not to use costly preparations except when absolutely indicated.
“I must admit,” he said when I had made my little speech, “that most of these prescriptions seem to have been signed by your assistant, Dr Perfect.”
“What is it that he has been prescribing to excess?”
“The Pill,” he said. “Every female in your practice must be taking it.”
The Pill. It explained the growing “way in” atmosphere in our waiting-room.
Fred’s only suggestion was that I stuff the man from the Ministry and he assured me that since his birds wanted love not babies, he would continue to prescribe the pill, whether it was allowed or not.
He soon had Sylvia eating out of his hand like everyone else. She sewed on his buttons, nourished him with rivers of coffee and mountains of chocolate biscuits. It was on the day that I came back to find her cutting his hair in the sitting-room with the scissors which I used for removing stitches that I accepted Dr Malleson’s offer.
I met him at the wedding of one of my patients. I hadn’t quite been in practice long enough to be attending the weddings of those whom I had assisted, for better or worse, into the world, but little Molly Saunders couldn’t have been more than five or six years old when she fell off the garden swing less than a week after I had taken over my present practice. A distracted Mrs Saunders had opened the door and when she saw me said: “Oh dear, my daughter’s had an accident and we were waiting for the doctor. Perhaps if you’ve got a car, young man, you could run us down to the hospital.”
I had matured since then. So had Molly. Her lip was faintly scarred even now but on her wedding day nothing could cloud her radiance. The fact that her bridegroom’s name was Malleson had not rung a bell until I collided in the crush at the bar with Toby.
“What are you doing here?” he said slopping champagne down his tie.
“Molly’s a patient of mine. What are you?”
“She’s marrying my nephew. Think it will stain?”
It took me a moment to realise that he was talking about the champagne.
“Don’t know what Slaridges is coming to,” Toby said, glancing over my shoulder.
I looked behind me and there was Fred in blue and white striped shirt and slacks with a red carnation behind his ear.
I beckoned to him. “This is my new assistant,” I said to Malleson and felt him blanch. “Dr Perfect.”
“Fred, meet Dr Malleson, Consultant Psychiatrist at Mark’s.”
“I heard you had a new assistant,” Malleson said, unable to take his eyes off Fred. “I was going to ask if he was interested in psychiatry…can’t get anyone to help me…couple of sessions a week…miss Robin…”
“Don’t dig hospitals, man,” Fred said.
I could swear I heard Malleson breathe a sigh of relief.
“My principal here,” Fred said, putting an arm round my shoulders, “…been too long in GP, man, needs turning on.”
“Turning on?”
“Can recommend him, man; ancient, old-fashioned, salubrious, undeteriorated, clean-living, law-abiding, non-indolent, self-supporting, nondescript, ineloquent, non-arty, unintellectual, free-thinking, unpossessive, teetotalling (Well, almost)…”
“Fred,” I said, “you’re drunk!”
“Nevertheless,” Malleson said, “it’s not a bad idea.”
“Take no notice of Fred,” I said. “I know nothing of psychiatry. Besides which there is no time.”
“Let Perfect here take care of some of the routine stuff. You’re probably getting rusty after all these years…”
He’d hit me on the raw, standing next to Fred I felt about a hundred.
“…why don’t you give it a try? Come and sit in with me for one or two sessions and see how it goes. You’ve no idea how difficult it is to get a clinical assistant who’s any good.”
“What makes you think I would be?”
“Just a hunch,” Malleson said. “Just a hunch.”
So it was that Tuesday afternoon saw me heading for the ancient precincts of St Mark’s to sit at the feet of the master. Toby Malleson was an accepted expert in this field, his patronage however could not get me into the hospital car-park.
“I’m Dr Malleson’s new assistant,” I explained with some importance to the porter on the gate.
“I’m sorry, sir, hospital staff only.”
“Where am I supposed to park?”
“Couldn’t say, sir. Might try the Minicipal behind the Bowling Alley…”
“But that’s miles away.”
“Might be able to pick up a taxi from there. Otherwise there’s the meters.”
There were the meters all right, but not one of them vacant, nor likely to be in the busiest part of London at the busiest time of day. I was fed up with my clinical assistantship before I had even started. I parked, as had been suggested, behind the Bowling Alley and took a taxi back to the hospital wondering whether they would pay my expenses when they weren’t even paying me.
My first steps inside the hospital, although it was not my own, took me sharply back to my medical student days. The same notices flapped indolently on the same notice boards. “Symposium on Hyperglycaemia”. “Wine and Cheese party” to be given by the St Mark’s Women’s Guild. “Freshers’ Hop” …
After much wandering round a maze of corridors in which no one paid me the slightest attention I seemed no nearer to finding the Department of Psychological Medicine, but did succeed in stumbling across an enquiries desk which I had passed some ten minutes earlier on my way in.
“Follow the red line,” a voice from behind hair said, not troubling to look up.
They hadn’t been such cheeky young pups in my day, I thought, looking at the floor with its tangle of red, blue and yellow lines. I followed the red for what I guessed was a mile and a half and came across a door that looked as if it was the entrance to a public lavatory. It bore the legend “Psychological Medicine. Please see Sister before proceeding”. I gathered I had arrived.
Another voice from behind hair said: “Name and letter from your doctor; take a seat over there,” and stuck out a hand.
“I’m Dr Malleson’s new clinical assistant. If you’d just tell him I’m here.”
“Second door on the left down the corridor.”
“Thank you for your help.” The sarcasm was wasted.
Sister was the next obstacle. She found me wandering down the corridor looking for the second door on the left.
“I’m afraid you have to wait your turn,” she said, “unless you’re looking for the Gent’s. Follow the yellow line and ask again at Pathology.”
I did my song and dance routine again and she allowed a wintry smile to cross her face and showed me into Dr Malleson’s room. Room! Well you could have called it a cell. You would not have thought that he was the senior Consultant at one of the finest teaching hospitals in England. It really was a disgrace. The room was empty, no sign of Dr Malleson although it had his name upon the door.
“I say,” I said, darting out into the corridor, “I say, Sister!…”
The corridor was empty save for a coloured orderly pushing a tea trolley. She looked at me with sympathy as if I had come to the right department.
Four
I went back into the room and shut the door, feeling like a criminal. I had just sat down at the desk which occupied a large proportion of the floor space when the door burst open and a Staff-Nurse put her head round it, did a double-take, said: “Oh, I was looking for Toby,” and disappeared.
“Toby.” Why hadn’t she said “Dr Malleson”? Dirty work at the
crossroads? One never knew with anyone.
The door opened again, this time it was the Secretary with the hair.
“Oh! Where’s Toby?”
She didn’t wait for an answer either. I was beginning to wish Toby would return from wherever it was he had seen fit to disappear to. I had hardly time to test the degree of swivel on the swivel chair when I was again interrupted. It was beginning to make me nervous. This time a timid little man with soulful eyes and a black moustache came hesitantly into the room and stood, waiting.
I cleared my throat. He stood quite still like a pointer.
“Cuthbert,” he said.
He seemed poised ready for flight and remembering I was now dealing with psychiatric patients guessed it best to gentle him along.
“Is this your first visit?”
He nodded.
“Well, won’t you sit down?”
He glanced at his watch.
Ah, I thought, obsessional.
He sat on the edge of the chair. The least I could do, I thought, was to take a history. If I did it very slowly perhaps by that time Toby would be back.
I took out my pen and drew towards me a sheet of hospital notepaper from the stack on Toby’s desk.
“Now, Mr Cuthbert,” I said, “can we have your full name, please?”
He glanced towards the door. Agoraphobic perhaps, dislike of enclosed spaces.
“Williams,” he said.
“You mean William.” I wrote William Cuthbert on the paper.
“Williams.”
“Williams Cuthbert?”
He looked at me with suspicion and then towards the door again.
“Cuthbert Williams.”
“Of course; how stupid of me. Now let’s see, Mr Cuthbert, I mean Mr Williams…” I loosened my tie, it was very hot in the cell, something must have gone wrong with the heating system.
“How old are you, Mr Williams?”
“Fifty-three.”
“Occupation?”
He gave me a queer look. “Clerk.”
“Splendid. Now your parents. Are they both living?”
He shook his head.
“Well, let us take your father. What did he die from?”
“Childbirth.”
“No, your father, Mr Williams?”
“Childbirth.”
I waited.
“There was eight of us, you see, boys. When another come along my Dad couldn’t stand it.”
“Coronary thrombosis perhaps?”
He shook his head. “Childbirth.”
I tried another tack.
“How old was he?”
“I dunno.”
“Approximately?”
“I dunno. I never seen him.”
“You’ve never seen your own father?”
“Oh he wasn’t my father. My dad was a seaman, married a girl in Fiji. Bigamy, only they never caught up with him. My mother took up with this fellow and went to live in Ireland, he was a poacher…”
I put down my pen, certain that some totally unrelated poacher in Irish waters could not have any bearing upon Mr Williams’ mental health.
Fortunately at that moment the door was opened once more and to my utter relief Toby Malleson bounced in.
“Frightfully sorry, old boy, just had an overdose admitted. Panic stations.” He looked at my patient. “What are you doing, Cuthbert?”
Cuthbert stood up and looked at me reproachfully. “I was making a collection,” he said, “for the Professor’s silver wedding.”
Surreptitiously I screwed up the sheet of paper on which I had attempted to write his history and put it in my pocket.
“I suppose you can’t lend me a quid?” Toby said. “My wife cleaned me out this morning. Something to do with the church bazaar.”
Cuthbert entered his name in a book and left as I painstakingly examined the view from the window, a courtyard stacked with oxygen cylinders.
The Staff-Nurse came back in. “Oh there you are, Toby. Jean says can she go early? She’s got tickets for ‘The Ring’.”
“Who’s Jean?” I said when he had given his permission.
“Sister. She runs the place.”
“That bad-tempered one I saw when I came in?”
“She’s not bad-tempered. You just have to know how to treat her. I advise you get in her good books.”
I appeared to have got in the bad books all round so far.
“Doesn’t seem to me much respect in the department,” I said. “I mean they all call you Toby.”
Toby seemed to think it not worthy of comment. Perhaps I had been too long away from hospitals.
“Now,” he said as I vacated his seat. “Down to business.”
The door opened. This time it was Jean. “Thanks, Toby,” she said ignoring me completely. “I’ll leave all the notes with Daphne; and Tommy wants tea now as he has some roses arriving from the nurseries and wants to be home in time to welcome them.”
“Tommy?” I said, my head beginning to spin.
“The Professor! He has an absolute thing about roses.”
Half the afternoon had gone and we hadn’t seen a single patient.
Tea was served in a slightly larger cell in which were one table and no chairs. Toby instructed me to the Professor, the three Senior Registrars, the Child Psychiatrist, a Behaviour therapist, various psychotherapists, the nursing Staff and psychiatric social workers attached to the department. Not one of them spoke to me, nor indeed to each other. Apart from desultory requests for the single sugar bowl for which they appeared to have to steel themselves to ask, not a word was spoken. A keen interest seemed to be aroused by the ceiling but on examination I found it to contain nothing more stimulating than one or two not very extraordinary cracks. If this was psychiatry, give me general practice. No wonder Robin had killed himself. The atmosphere was enough to inspire the most stable personality with suicidal tendencies. One by one they finished their tea and slunk out. The Professor, who you wouldn’t have thought out of place had he called to clean your windows said: “Ena Harkness,” to Toby as he left.
“Brilliant man,” Toby said. “Brilliant.”
He appeared to be quite serious.
In the Gent’s lavatory which was the next stop on our itinerary Toby said: “Everyone who needs a doctor is to some extent disturbed and unhappy. Unless the patient can be understood as a person his chance of being helped is poor indeed.”
It was my first and most important instruction in psychiatry and it was given while Toby was buttoning his flies.
We strolled slowly back to Toby’s room, stopping on the way to chat with various nurses, secretaries, orderlies and the dozen or so patients who waited, seemingly prepared to do so for ever, in the rows of chairs provided for out-patients in the Department of Psychological Medicine.
When we finally returned to his cell Toby sat on the swivel chair at his desk and pulled out a folding chair for me at his elbow. He then made a telephone call to his wife in Esher to inquire if they had delivered the oil for the central heating.
When he had replaced the receiver I looked at my watch and said: “Aren’t we actually going to see any of the lunatics?”
Toby said nothing. He screwed up his fountain pen which he had just unscrewed, laid it neatly on the clean sheet of paper on the desk, got up from his chair and walked to the window. To the oxygen cylinders in the yard he said:
“In the presence of physical disorder man has a precious natural humility. If we see someone afflicted with a crippling illness or injury we feel an instinctive sympathy, a desire to help or comfort, at least as far as we can. Sick or injured people are a challenge to our emotions as well as to our communal responsibility, but man has not always felt the same. Not so very many years ago a man with sick dependants was advised to leave them lying where they were or even, if he so desired, to put them out of their misery by burning.”
I looked at my fingernails, anxious to get on with seeing patients and feeling my whole afternoon wa
s being wasted.
Toby went on. “Such an attitude sounds utterly barbarous, callous and inhuman to us now, but we are separated from it by nothing more substantial than time, and a mere seven hundred years at that, a fragment of the span of human history.”
I had not come for a history lesson.
Toby came up to my chair and stood over me so that my face was close to his belly.
“We no longer use the term ‘lunatic’…”
“I was only joking.”
“…There is no such thing as a joke!” He sounded really angry. “It betrays the same emotional charge of contempt, horror and derision, or at the very least condescension, as used to be reserved for the physically ill. ‘Mental illness’ might be a euphemism or polite fiction, my lad, but it does not betray an attitude of rejection and separation as do ‘madness’, and ‘lunacy’.”
I opened my mouth to apologise for my choice of words but Toby had not finished with me. He gestured towards the door. “Those people you saw out there are sick. They are sick just as your cancers, your gastro-enteritises and your tuberculoses are sick. They are experiencing the whole range of disturbance of human emotion, judgement, action, and personality. They are anxious, tense, unhappy and confused. They are undergoing a simple failure of mental development, failure to meet the increasing requirements society has imposed upon them, from sheer personal inadequacy as well as the more dramatic violent disturbances you no doubt imagined you would see here this afternoon. Out there there are no ‘lunatics’ or ‘madmen’, merely ‘people’ with that aspect of human suffering we name, for want of a better label, mental illness. At one time they would have been burned, tortured or imprisoned. They are still too often,” he looked at me, “neglected, exploited or merely treated with indifference by so-called normal people; even, tell it not in Gath, by members of the medical profession. Each one of us makes his own compromise with reality. These people, all of them, are having difficulty with making a realistic adjustment between their hopes, desires and fears on the one hand, and their experience of life as it actually is on the other. They either aggressively reject life or passively succumb to their inability to accept it. These are the patients with which you will find the psychiatrist is concerned.”
Practice Makes Perfect Page 3