by Ruth Skrine
Bion’s writing about small groups suggests they function in one of two modes, the work group and the basic assumption group where members act out unconscious strategies to avoid painful work. Tom never referred to any theories, but the workshop digests demonstrate many of the difficulties met in helping trainee doctors to belong to the former group.
Over the years I have led groups in many parts of the country. My travelling was comparable to that of many participants who, especially in the early days, paid their own expenses. I certainly paid for all my travel during training, only being reimbursed and eventually paid a fee when I started to lead. Like most of my contemporaries I was a woman working part-time with a husband who provided basic financial support for the household. We were happy to give our time and money for the unique training that grabbed our attention and filled a gap, not always recognised as more than a vague dissatisfaction, in our understanding of patients and their needs.
Now, most women doctors can get other part-time work and their households have been designed with the expectation of two salaries. Sexual problems are recognised as underlying much unhappiness and some illness. All doctors are expected to have some training in the recognition of such difficulties and to be aware of places to which their patients can be sent for help. Some doctors apply to the IPM for training because their employing authority has sent them or because they like the idea of another qualification – with such motivation they are unlikely to gain much insight.
The publication of the workshop transcripts was an important step in my working life. Although I was never an innovator, I had taken on the job of trying of capture the highly original ideas and method of training that was developing within psychosexual medicine. In both my family and my professional life I was on my way to becoming a member of the senior generation.
When my mother fell and broke her femur I was in London to present a paper at an IPM meeting. She was in her flat and managed to crawl to one of the panic buttons we had put in each room. Ralph went through to find she had a bag ready packed for such an eventuality. The ambulance took her to a private clinic. I caught the next train home, to find she had been prescribed bed rest in the hope that the simple break would heal itself. During that time she appreciated being called Dr Hickson by the staff. She enjoyed the care, the tasty meals and the single ward with a view over fields, the flowers and letters from well-wishers. But a week later her fracture showed no sign of healing. Her consultant decided he must operate. I went with her to the door of the operating theatre where she looked into my eyes and clutched my hand. I reassured her that I would be waiting for her when she came out. I was, once again, the adult to the frightened child – as I had been for those few days following the death of my father.
Back on the ward she floated on the edge of consciousness. After twenty-four hours we were told she had sustained a massive heart attack under the anaesthetic and was not going to recover. Arthur sat with me by her bed while a nurse did everything she could to make her comfortable, keeping her mouth moist and every part of the body supported in a comfortable position. Half an hour before she died the nurse asked me what my mother’s first name was. When addressed as ‘Joan’ her eyes flickered. I was deeply moved. This passionate, powerful woman who had been my mother had regressed to the stage of an infant. I am comforted by my belief that hearing her name in those last moments ensured that she did not feel deserted or alone. I held her hand and Arthur held mine, a line of support I tried to extend across the Atlantic when I phoned Biz later. She, however, was in the middle of hosting a dinner party and with typical stoicism continued being polite until her guests had left and she could share the news with her husband and seek what comfort he could offer.
I mustered some words to thank the nurse for her sensitive care of my mother during those last few minutes of her life. She told me she had nursed her own mother to the end and that the personal experience had taught her the importance of adjusting one’s responses to the moment by moment changes in each patient as they slipped towards death.
Again, Arthur and I were faced by a funeral. Knowing our mother would hate to have even the simplest prayers said over her, we asked the undertaker how it could be done. He said quite simply that the coffin would be in the crematorium. We could go in and sit down. When we wanted it to disappear we should stand up. So we did just that. She always hated bought flowers, they were a waste of money, garden bunches were much nicer. So, after forcing the buds to open by putting them in a warm oven, I placed three Iris stylosa blooms on the plain wood. They only last a day so it was appropriate that they should burn with her.
As we drove back to Bath after the ‘non-funeral’ I told Arthur about the time, only a few months before, when our mother had climbed into one of my compost boxes, made of wooden planks, in order to paint them with preservative. She loved to help in the garden and I did not resent what I would have considered intolerable interference earlier in my life. I tried to suggest simple tasks that she could manage easily and had meant her to treat the wood from the outside. But she was determined to do the job properly. When I came home she told me, with a laugh, ‘I found myself wishing to die at that moment, in that place. Then you would not have the trouble of moving my body but could build me into the layers of compost.’
Arthur and I managed to laugh too, at our practical but impossible mother, whom we had loved despite her tempestuous temperament.
17
Surviving
After the publication of the workshop transcripts, Jimmy and I published a multi-authored book Introduction to Psychosexual Medicine under the same imprint, Montana Press. The name occurred to him one day as we sat with Ralph in the garden near a prolific clematis that had draped itself round a pear tree, one of the last of the monastery trees, not destined to live for many more years. Among my favourite photos is that of Helen and her new husband Simon, taken in front of that tree with its mantle of white flowers, soon after their return from honeymooning in Africa.
Ralph retired from the prison service when he was sixty, in accordance with the regulations. The year was 1984, appropriately synchronous with Orwell’s book. He would have found the prison service with its modern ethos of privatisation a difficult place to work. In retirement I had expected him to become a keen member of the Bath chess club for he had played by post for many years. However after attending a few times he stopped, preferring the distance of correspondence and the impersonality of a computer. In the hope of prying him out of his chair into the open air I acquired a replacement dog. Bess had died a couple of years before. Cassie was a collie/Labrador cross with her own problems. She had eczema and the steroid tablets needed to keep it under control gave her a ferocious appetite. She stole any food within her reach. If allowed to run free in the fields above our house she disappeared into the bowels of the skips at the back of the university, where they chucked waste food. I was not firm enough to train either of my dogs.
On the second occasion Ralph took Cassie for a walk he sprained his knee and the excursions never resumed – but he could walk into the town to buy tobacco for a variety of pipes. He stopped smoking at frequent intervals but was always so miserable that I had difficulty waiting in silence during the few days before he restarted. Although I hate the smell of tobacco now, at that time I trained myself not to notice. After he died I buried my head in his tweed jacket, straining to reach a whiff of memory, with as much effort as Cassie strained for her stolen food.
Thus I have come to the moment I can no longer avoid – the plunge into the well of memory that leads to widowhood. 1990 was my annus horribilis, despite the fact that it started so well with the safe birth of Alec, my first grandson. Six weeks later Jimmy Matthews died suddenly of a ruptured aortic aneurysm. In November Ralph had a heart attack. He had spent a restless night, feeling sick and uncomfortable but not complaining of severe pain. As soon as it was time for our doctor’s surgery to open I phoned and asked for a visit. ‘If he says it is just indigestion I will smash
his face in,’ said my husband who, since his discharge from the army, had never raised his hand to anyone, and who could not kill a wasp.
Our GP had just come in from another urgent visit and was about to start morning surgery. I had an image of his waiting room filling up with restless patients. ‘Do you want to see a few before you come?’ I suggested, identifying with his predicament. ‘I could give Ralph an aspirin in case it is a heart attack.’
Luckily he heard the panic behind my words and was on the doorstep within a few minutes with his ECG machine in his hand. The tracing confirmed our fears. Dr King stayed with me until the ambulance arrived to take Ralph to the Intensive Care Unit at the Royal United Hospital.
The treatment he received was meticulous. He was quite poorly for several days. I remember sitting with Helen in the small relatives’ waiting room, unable to let go of her hand as she tried to comfort the mother of a boy who had crashed his motorbike and suffered a severe head injury. Corralled in the bubble of my own pain and anxiety, I could not utter a word.
During his time in hospital Ralph turned to Helen for comfort and reassurance. He relied on her medical knowledge and trusted her in a way he never trusted me. She was wonderful, bringing small offerings each day but more importantly just the reassurance of her presence.
After about three days the various tubes were removed from his body. I was sitting by his bed when the nurse in charge (she was probably no longer called a Sister) asked if anyone had washed his feet. When he said no she fetched a basin of water and descended to the floor.
‘Surely you must have a minion who could do this?’ Ralph asked. ‘You are much too senior for such a lowly task.’
‘Good enough for Jesus, good enough for me,’ came the reply, as she soaped between his toes.
When he was eventually moved onto a general ward the contrast was harsh. Here, we could have entered a third world country. The floor was not very clean with the beds close together, the room crowded with visitors who arrived early and stayed all day bringing food, flowers and titbits of gossip to entertain their relatives. The ward was for diabetics and the ever-changing staff had no idea how his exercise level should be graded after a heart attack. I tried to work it out with Ralph, not sure if I should allow him to walk to the toilet or fetch a wheelchair, uncertain when he should be encouraged to try a few stairs.
One kind act stays in my mind. A bed next to the window became vacant and a nurse suggested he might like to move into that privileged place. The change made an enormous difference to his comfort. Now he could turn away from the people and the noise and let his eyes travel up to the skyline where clouds moved, fast or slowly depending on the wind, in ever-changing patterns.
I never wrote the letters of thanks that I planned to the intensive care staff or to that nurse who had noticed that he was suffering, perhaps more than some of the others, a hermit confined in close proximity to a sample of seething humanity.
His stay was made worse by the fact that it was a mixed-sex ward. A few years before he had been admitted to a male ward for an operation on his Dupuytren’s contracture, a thickening of the tissue in the palm that pulls the fingers into a claw. I had been afraid he would find a general ward difficult but when I visited a few hours later he was in charge of the tea trolley. ‘Over here, Gov,’ the men were calling. ‘Two sugars for me, Gov.’ He was back in an all-male society that he understood, and had instinctively taken the role of the officer caring for his men.
A couple of days before he came home after his heart attack, I was standing at the sink thinking that the one person I would like to see was my sister. The idea startled me for we had never been very close. In my despair I was searching for some contact, any contact, with the world of my childhood where I had been safe and where it never occurred to me that any tragedy could touch my family.
I turned from the dishes – and there was Biz walking in at the front gate. Her husband Jim had insisted she came to support me and she had leapt onto a plane in Virginia and come. Surprise and gratitude overwhelmed me.
Where Americans are able to show their sympathy, our British reserve makes it difficult. I am ashamed of the time when I did not visit a relative whose husband was dying of dementia at an early age. I had told myself that there was nothing I could do. Now I know that just being there is something – only cowards are paralysed by their own inadequacy.
Biz stayed for a few days making welcome-home posters for Ralph. After his return home she peeled vegetables and disappeared to her room at appropriate intervals. When she left I was torn between the wish to spend time with him and my duty to return to work. Helen insisted I stay off for at least six weeks and ever since I’ve been grateful to her for helping to solve that dilemma. Those six weeks were very important for us a family. We had the baby Alec to stay while his parents had a night away. Ralph was afraid to pick him up, as he had been all those years ago with Helen. He had not met a baby since that time, thirty years before. But he would kneel down and make faces and baby noises to entertain his grandson whenever I left them together. One picture remains vividly in my mind. After taking Alec into our bed in the morning, I had gone downstairs to make a cup of tea. When I returned the two chaps were lying in our big bed, their heads side by side on the pillow.
Supported by Helen, we grew very close. Ralph read poetry, sometimes aloud. He took short walks in the garden, a place he had seldom ventured when he was well. Until that time he had declared that he would be happy with green concrete. After six weeks he died suddenly, sitting in his chair. Again, I planned to write to the hospital to explain that, although they might feel his death so soon after discharge from hospital had meant their efforts had been in vain, the importance of the time they gave us could never be explained in words. Perhaps this was the reason the letter was never sent.
Much has been written about bereavement, yet my experience suggests that the advice is often misplaced. ‘Stages of grief’ have been described, with rules for the time each stage should take. My sense is that there are no rules, every person survives, or does not survive, in their own way. Talking to friends who have lost their partners we agree that the complete process can take up to six years, perhaps even longer for some. Until the end of that time I felt that part of me was still buried with his ashes in the crematorium. I would sit up in bed after I woke, my favourite place and time for remembering, weeping and putting some thoughts onto paper. On the sixth anniversary of his death I wrote a poem and when it was finished I knew I had dragged myself out of his grave and was now a whole person again.
Looking back from my vantage point twenty-one years later I wonder if the poem was the result – or the cause – of the healing. At the time I had been in analysis for four years. I had cried during much of my time in that room, without being clear what I was crying about. In the rare sessions when I did not cry I was left parched, as if the day held no possibility of new life, like the dry, infertile days of the menstrual cycle. As far as I can understand it now, much of the work had been concerned with differentiation from my mother, a necessary step in the process of separation from my husband. Writing this memoir and reliving some of the past has extended that process. . . I am free to love him with even more of myself.
During this period there were of course times when I forgot and could enjoy immediate activities. These intermissions became more frequent and the time between patches of hopelessness grew longer. I was only sixty-two when he died and still had enough energy left over from grieving to devote to the struggle back to a new life. Very old people with reduced energy levels find the effort doubly hard and I am not surprised that many die within a short time of their loved one.
I had dealt with day-to-day family finances all our married life so the practical tasks of paying bills and running the house were no burden. More difficult was deciding what bread I wanted to buy. As with all food, Ralph had been fussy: square, processed white or nothing. I wandered round the supermarkets with no idea what I wanted to buy.
In the end I closed my eyes, walked a few paces and reached for the first loaf I touched, only putting it back if it was square and white.
With little understanding of my motives I found myself making a collage of four women and their babies from sixty years of photos kept jumbled in a suitcase. In the top left-hand corner all generations are shown together. My grandmother sits on a garden seat holding Helen, a few weeks old. I stand behind in a floral summer dress, inherited ivory beads round my neck, which I seldom dare to wear in public. The killing of elephants for their tusks is quite unacceptable but this material was culled many years ago and I can’t put it back. Luckily it never occurs to people to consider that it is anything but synthetic. The line of my gaze blends with that of my grandmother, both of us besotted with the baby. My mother also sits on the seat, looking straight ahead with a stern expression.
Below this generational group are pictures of each woman with her offspring. My mother at about two years already looks rebellious. Where she is holding me I can just make out an arm round my waist, she would not actually wish to drop me, but the more obvious hand is reaching down to her beloved dog Jimmy by her side. In other pictures two toddlers sit on different doorsteps. One is myself with curly hair, looking happy. Once, on being shown a picture taken by one of my mother’s friends, I had burst out, ‘But I was a pretty child.’
‘Of course you were,’ my mother snapped, ‘but we would never have said so to you or anyone else.’
Helen, on her doorstep, has very short hair and could be mistaken for a boy. Her expression is searching and not easy to read. Next to that image she is smiling as she holds her own baby aloft, the most joyous mother of us all. The men are all present but mostly in the background. The only way I can understand my obsession at the time is to notice the emphasis on babies, as if in the presence of death I needed to remind myself of the cycle of life and the possibility of new beginnings.