Practice Makes Perfect

by Rosemary Friedman

  Although, however, the presenting complaints remained ostensibly the same, the more I became involved in my clinical assistantship to Toby Malleson the more I became aware of the relationship between the patient’s emotional life and health; a fact which before I had only dimly recognised. I noticed particularly the large group of women, mostly married and around the forties, who drifted between bladder specialists, womb specialists, stomach specialists and gall bladder specialists, as a result of their failure to find marital happiness. When I explained this to Fred, he said: “Balls!”

  “Look,” I said, “when somebody has been crying they are left with a swollen, blotchy face. You are not going to tell me that this is the result of a physical illness?”

  He did not.

  “It is simply,” I went on, “the fact that a prolonged emotional state has brought about physical changes, in this particular case obvious and explicable ones. You cannot deny their emotional origins, not even to yourself.”

  He did not try to deny them.

  “Right. Taking the matter further, is it not possible that in illnesses where the emotional element is an obvious part of the disability, such as depression, corresponding changes in the stomach may take place – it becomes pale and grey, covered with mucous, ready to bleed and develop an ulcer. Between your blotchy face from weeping, and your stomach ulcers from other emotional causes you have your anginas and your asthmas, your rheumatoid arthritis and your migraines.”

  “What about your broken legs?” Fred said. “You could cry till Domesday without fracturing your fibula.”

  “You think that’s funny,” I said, “but let me tell you that although a broken leg or a sprained ankle is in most cases entirely a physical misfortune…”

  “You don’t mean it?”

  “…there will inevitably be an emotional side to it.”

  “I thought somehow there would be.”

  “The patient may have fallen down because he was worried, anxious, impatient, or in a temper, just as Professor Higgins fell upstairs because he was cross with Eliza Dolittle.”

  “He may also have gone arse over tit on a banana skin.”

  “Exactly!” I said in triumph. “But have you considered why he trod on the banana skin? Because he was accident prone as a result of continued tensions, anxiety, frustrations and resentment!”

  “Balls!” Fred said, which was where I came in. “He just slipped on a banana skin, man!”

  It was useless to pursue the discussion. Fred had his own ideas on medicine and I had to admit that I respected them more than he respected mine.

  He had a “thing” about incurable diseases.

  “You don’t have to be a doctor to treat pneumonia, man,” he had said to me in the past, “all you need is a bottle of penicillin. It’s the incurable diseases that are really worth treating – the ones that make demands on one as a physician. When someone is in constant pain, man, and knows he can only go from bad to worse, along with your analgesics you have to give him faith in the future, cheerfulness, freedom from depression, and help him to develop a philosophy to deal with the uncertainties of the disease. You’ve got to help him live, man. For this you are a physician.”

  And he practised what he preached. He did not believe that it was gallant to suffer and said unrepeatable things to patients who told him that pain brought them nearer to their Maker. Often, neglecting his list of visits, he would spend an entire morning instructing an arthritic patient in the art of collecting stamps in order that he could find some satisfaction in his life of pain. He compiled reading lists and fetched books from the library or his own collection for bed-ridden patients, in order that they might fulfil themselves intellectually. Odd he might have been, but he was remarkable in that he personally assisted countless people to endure their daily, unpleasant, ration of pain.

  According to Lulu, who indefatigably dealt with the telephone, more and more patients, when ringing for visits or advice, began asking for Fred. Imperceptibly the practice began to split down the middle and we developed our own particular clientèles. Despite his professed cynical view of psychiatry, Fred continued to refer any patients whose problem seemed to lie in this direction, with as much speed as he could to me. Often they were accompanied by terse notes which made it difficult for me to keep a straight face. “Thought you might cope with Mr Green who has trouble with his ignition.” I discovered he was unable to make love to his wife. “Am sending down Mr Jones who sometimes forgets how to spell his own name. Yours sincerely, Phred Perfikt.”

  Take the micky as he might he was fully aware of the increasing role psychiatric problems were playing in the practice. He knew as well as I did that the symptoms of anxiety or “fear spread out thin”, could be just as distressing and at times more so than those of burns, boils or blisters. To me they presented a challenge to which I felt myself unequivocally drawn and I waited eagerly for Tuesday each week and my session at the hospital.

  After several months, during which I received no more recognition than the buttons on Toby Malleson’s cuff, I was beginning to become accepted, in the lower echelons at least. Jean, the Sister in the Department, had asked me in a moment of intimacy whether I thought she should marry her current boyfriend who had a Lamborghini but no money in the bank. Daphne, the Staff-Nurse, now smiled at me each time I appeared, and even the Professor had actually addressed me.

  It was after a clinical meeting, of which we had one on the last Wednesday of every month, and it had come as a complete surprise. At these meetings one member of the department was usually invited to discuss his cases and generally provide the entertainment. On this particular Wednesday the entertainment was more than we had bargained for and I felt that it was fortunate the sessions took place in private, by invitation only, and behind closed doors. The talk was given by one of the Behaviour therapists in the department and he accompanied his lecture with a series of slides, illustrating how he dealt with a variety of phobias, and anti-social tendencies, including some of the more way out sexual perversions. A bluer lot of films could not, I swear, have been unearthed in Soho. The lady psychiatric social worker next to whom I was sitting during the performance found great difficulty in knowing where to look and one of the Senior Registrars sat through the entire performance sucking his thumb. The sherry was served in more than the usual silence.

  “Have you met my new assistant?” Toby said to the Professor, who was dispensing the wine, introducing me for what must have been the tenth time since I had been working with him.

  “Lucy Cramphorn is immune to mildew,” the Professor said, “sweet, medium or dry?”

  I wasn’t sure if he was referring to the mildew or the sherry and wondered what it had to do in any case with Lucy Cramphorn.

  “Sweet,” I said, taking a chance.

  “You must come and see the Queen of Denmark…” he said to Toby.

  “Love to Tommy; love to.”

  I wondered what was the matter with her.

  “…there is nothing like her perfume on a summer night.”

  I wondered whether the slides we had seen had affected him, then realised that as usual he was talking about his roses.

  “Have you actually been to his house?” I said to Toby, when he had moved on, leaving me with my glass of sweet sherry which I hated. “How long do you have to know him for before that happens?”

  “Twenty years,” Toby said. I reckoned he would be dead by the time my turn came round. “I was one of his students.”

  “Does he ever talk about anything except roses?”

  “Azaleas,” Toby said, “but not so much since they got rid of the shrubbery.”

  “What’s his wife like?”

  “Alice? An absolute pet. Slightly on the vague side. Inclined to invite you for dinner and then forget. You end up with kippers in the kitchen.”

  I pictured some gaga old lady.

  “She’s an Oceanographer,” Toby said. “Fellow of the Royal Society. She’s usually lecturing on on
e side of the world while Tommy’s lecturing on the other. They meet occasionally changing planes.”

  “You wouldn’t think,” I said, scratching my head, “that such vague people…”

  “Vague?” Toby looked puzzled. “Tommy is a world authority on the Biochemistry of Mental Illness and as for Alice…”

  “It’s just that he talks of nothing but roses and doesn’t appear to know what is going on.”

  “He knows what’s going on all right…”

  The Professor filled my glass with sweet sherry silently and moved on.

  “I see what you mean,” I said, beginning to, as I watched him move among the hundred-odd people and recalling exactly whether they were drinking their sherry sweet, medium or dry.

  Fifteen

  “It’s obviously just an act,” Sylvia said when I described to her the Professor’s extraordinary behaviour.

  “But it isn’t. That’s him. You don’t understand.

  “Why don’t you ask him to dinner?”

  “To dinner!”

  “We do have people to dinner, remember?”

  “I couldn’t possibly ask the Professor. He is barely aware of my existence. In that Department I am the lowest thing that creeps.”

  “If you ask me,” Sylvia said, “you need some treatment.”

  I thought of the Psychiatric Department as a whole.

  “If you ask me,” I said, “I’m beginning to think we all do; but then perhaps that’s why we all got interested in the subject in the first place.”

  “Rubbish. You started because Toby Malleson asked you at Molly’s wedding.”

  “But I didn’t have to stay. I’m getting curiouser and curiouser. I may even give up general practice one day.”

  “Well, before you do,” Sylvia said, “you might go and deal with Christopher Murphy’s nose. It’s been bleeding for the past hour.”

  “Where’s Fred?”

  “He’s gone shopping.”

  “He’s always going shopping.”

  “Yes, but he’s having a party tonight.”

  “Why hasn’t he asked us?”

  “It’s a sort of drop-outs party. We’d stick out like sore thumbs. I suppose we could go if we wanted to. There aren’t any invitations. People just get to know. You’re on duty anyway and I’m going to make a start on my new book.”

  I sat down and picked up the Journal of Psychiatry.

  “Christopher Murphy’s nose,” Sylvia said.

  “I wish we hadn’t moved,” I grumbled, “he was practically next door to the surgery.”

  I dealt with Christopher Murphy’s nose and was forced to accept Mrs Murphy’s gratitude in the form of a cup of tea so strong that the spoon almost stood up by itself.

  Thus fortified, I set out for home and the Journal of Psychiatry, stopping on the way at a telephone box to see if there were any more visits. There were; four. It was not my day.

  I drove along at twice the speed limit and suddenly, my mind on other matters, found myself being flagged down by a traffic cop in the middle of the road. I managed to stop, practically on his toes, and was preparing a dozen excuses in my mind when I noticed a pile-up of traffic not far behind him.

  “I would like to remind you, sir,” he said, sticking his helmet through the window, “that this is a restricted area. The speed limit is…”

  I gestured at the pile-up and flashing blue lights.

  “I’m a doctor,” I said. “I hurried along to see if I could do anything to help…”

  “We’d be very glad,” he said, suddenly brisk. “The ambulances haven’t arrived yet and we need the fire brigade to release one man. We would be most grateful for your assistance. Pull in on the grass verge, sir. Over there.”

  I left my car where he told me, grabbed my case, and dashed across the road. It was a horrible mess; broken glass, bleeding people, crying children, a caravan on its side, gaping sightseers. I couldn’t make out exactly what had happened but it wasn’t my job to do so. The man who needed the assistance of the firemen was pinned behind the steering wheel of his car, with what I guessed was a stove-in chest. I gave him some pethidine to relieve his pain. A woman, who hadn’t troubled to fasten her seat belt, had shot through the windscreen of her mini car and was bleeding from multiple lacerations; two small children, just setting out on their caravan holiday would, at a guess, spend the rest of it in hospital with broken limbs. An executive-looking type, a red carnation still incongruously in his buttonhole, would never have a holiday again. It was a truly grisly mix-up, among which police trod with walkie-talkies sending for aid, controlling traffic, keeping back onlookers, and trying to help those who were vomiting at the side of the road.

  Eventually ambulances came, more than were needed, fire engines by the quarter dozen, policemen by the score.

  I reckoned my services could be dispensed with and said so to the police officer who had originally stopped me. He thanked me for my services and escorted me back to my car. At any rate to where I had left my car. I stared at the empty grass verge.

  “Where was it now, sir, you pulled in?”

  “Just here. You told me to.”

  He looked up and down vaguely. “A little higher up, wasn’t it, sir?”

  “Here!” I said categorically. “Right beside the litter bin.”

  “Gravel,” he said.

  “Gravel then.”

  He said something incomprehensible into his walkie-talkie. Incomprehensible things were said back. He scratched his chin.

  “Nobody’s moved it, sir. Are you absolutely certain…?”

  “Look, officer, you told me where to leave it and that’s precisely where I left it.” I was getting angry. “It’s useless you telling me I left it somewhere else; I am not a complete idiot and I have several visits to do, I was on my way to do them when you stopped me, so you’d better jolly well find it.”

  He started scratching again; the back of his neck this time.

  A sudden, startling thought occurred to me.

  “It’s been nicked,” I said, “somebody’s nicked it!”

  “I was beginning to think that myself, sir,” he said. “As a matter of fact I just put a call out.”

  “Of all the damned cheek,” I said, “there am I helping suffering humanity…how am I supposed to get on with my work?”

  “Don’t worry about that, sir.” He stopped scratching and brightened up a bit. “I’ll get the squad car…”

  “That’s awfully decent of you,” I said, “but the squad car isn’t going to stand outside my door day and night. I need my car back.”

  “Let us take you to do your immediate visits,” he said, soothingly, “and by that time we hope to have located your own vehicle. They can’t have got very far. How much petrol was there in the tank?”

  “None,” I said, “not more than a teaspoonful anyway.”

  “That’s something. We’ll notify all garages. Now if you’ll kindly step over here I’ll have a word with Sergeant Panther, who will remain at your disposal until you can make alternative arrangements. We are extremely grateful for your assistance and do apologise for the disappearance of your vehicle, which we will do our utmost to recover.”

  I was about to follow him “over here” to be introduced to Staff Sergeant Panther, when my way was blocked by the bulk of an immense maroon Rolls Royce.

  “Darling, what on earth are you doing here?” Olivia Duke said, rolling down the back window. “Have you had an accident?”

  “There has been an accident,” I said, and explained to her what had happened.

  “Don’t worry about a thing,” she said, opening the door. “Watkins will drop me off and you can have him and the car for just as long as you like. You poor, poor thing.”

  My officer, who had been standing by, listening, took out his notebook and approached the open window.

  “Look, officer,” Olivia said, “we may have been going the teeniest, weeniest bit fast but…”

  “That’s all right,
Miss Duke,” he said, a broad grin splitting his face. “I just wondered if I might have your autograph. For the kiddies, of course!”

  Thus it was that I did the rest of the day’s visits in a maroon Rolls Royce.

  The patients looked at me askance, but not as askance as Sylvia.

  “You seem to be getting terribly involved with Olivia Duke,” she said. “If it’s not one thing it’s another.” She glanced out of the window at the Rolls outside, Watkins sitting at the ready in the driving seat. “You don’t honestly mean to tell me that your car was pinched under the very noses of the police…?”

  “I admit it sounds a bit far fetched?”

  “Far fetched!”

  “Look,” I said in triumph. “There is blood on my shirt. You can see for yourself there was an accident.”

  “I suppose it couldn’t have been Christopher Murphy’s nose?”

  I gave up and asked if any more calls had come in.

  “Caroline phoned. She said Bubbles feels awfully poorly and if you can spare a few minutes to see him…”

  I climbed into the back of my limousine and gave the address in Chelsea to Watkins.

  Faraday was never far from my thoughts. We spoke to each other on the phone several times a week, but he was working and so was I and we did not get much chance to meet. When I did think of him it was with a sinking heart, and thoughts that there but for the grace of God go I.

  His fever had not extinguished his humour.

  “Are you sure you’re able to get our street into your car?” he called from the window.

  It was not as odd as it sounded. His street was about five yards wide and lined with chi-chi and expensive houses, converted from what had once been workmen’s cottages. The Rolls, parked largely on the pavement as it was, left little room for pedestrians, let alone another car.