“To be a good doctor, one needs to be involved with patients (capable of empathy and humanity); yet to remain objective and survive emotionally, one needs to be detached from their pain and suffering.” Support 4 doctors 2016
Don’t Mention Her follows the story of Connie, a woman doctor. The idea for the novel started with her husband, Liam, walking through a gate, in 1963, into a convent garden in the middle of England. I knew the mood of that scene – he was grief-stricken, was in mourning and couldn’t express it. I wanted to know why, and what happened to that family over the next 50 years. The novel was inevitably going to describe quite drastic changes, not only for Connie and Liam, and for their Catholic family, but more crucially in the practice of medicine.
None of it is actually true, no five-year-old died, no characters are based on people I knew. I had no family history to call on, apart from parents who were doctors in Northampton. But I did have a sense as a child of a deadening, of loss and of secrets. Looking at Don’t Mention Her with its fictional characters I realise that despite all the invention it is full of something that is very familiar, something that was around the house in my childhood and un-named.
It might have been a fear of failure, of blame, or anxiety about either. It might have been the much more present threat then of death. My parents both started in practice before regular use of penicillin, when TB was a constant threat, before vaccination for polio.
In the fifties the ‘family doctor’, or GP, worked alone or with only a few others; there was no practice nurse, there were no hospices, more mothers delivered their babies at home. I would hear the phrase when I temped for the receptionist: ‘I’m under Dr X, we all are.’ Dr X had looked after that family from birth to death, day and night, with the occasional trip by the patient to the General Hospital for surgery.
In The Guardian recently the report of a GP’s suicide mentioned not just that she was being treated for bi-polar disorder but her ‘work-related stress’: she was dealing with the ‘death of a patient’. And, interestingly, she’d had to retire because a patient complained about her blog mentioning her disorder.
As children, there were no conversations at meals about patients. And it wasn’t just silence about work, both my parents’ lives had been marked by siblings dying and had said nothing. My father rarely spoke. My mother had switched to working full-time in public health and was more communicative but she was always rushing. Occasionally she’d talk about polio, pleased that the sugar lump removed the need for an injection, of her experience when pregnant of taking chest xrays for TB; of the prevalence of rickets before the government started handing out Vitamin D in orange juice.
But on some things she was less forthcoming: she came from a part of Ireland that within her great-grandparent’s memory, within their stories, was fatally damaged by years of famine. She was angry, and at the same time had no desire to go back to Mayo. There had been too much death, mostly from TB, even within her memory.
But probably it was my father’s silence that marked us most profoundly. His first wife died in childbirth as did the baby. It was their second child; he was left with a toddler aged two. And none of this was ever mentioned. We didn’t know that our oldest sister had a different mother, and neither did she until she was twelve. Years after he died, and shortly before her own death, my mother talked about it briefly. She believed that my father had felt responsible. But he’d refused to say a word.
Various relatives lived with us while they were assistants in the practice. I remember eavesdropping on a cousin taking a phone call about some tests; he reported the results to my mother – the patient was a girl I’d been friendly with since we were four. I could tell it was serious from their muted voices and expressions. Kathleen was an only child, adored by her Catholic parents; soon after her funeral, her parents split up.
Medicine has changed, Clare Gerada in the BMJ describes the new stresses on medical staff: ‘The NHS is exposed daily to negative stories in the media. Its staff are accused of being lazy, cruel, and uncaring, and the service is blamed for failing to meet necessary standards. Doctors, nurses, and managers are seen as villains and are berated by journalists….. who overlook the fact that the NHS still tops the list of what makes the public feel proud about being British.’
Well, the NHS, as we knew it, is disappearing into Virgin Care etc; they allegedly don’t even pay taxes on their profits. Soon the health service might no longer be part of our heritage. And no one mentions it.