Practice Makes Perfect

by Rosemary Friedman

  I began to feel, despite my many years in general practice, like a raw medical student.

  Toby switched on the voice-box on his desk and said: “Send in Mr Flipping, darling.”

  He was the first of the endless cavalcade that was to continue over the weeks. Patients who were worried but were not at all sure why they found everything so worrying. Patients who were afraid but did not know what they were afraid of, or why they were afraid of it. I saw, at first hand, fear spread out thin, a gnawing panic dreadful to the sufferer because he was unable to find for it any recognisable cause. They came complaining; of disturbed sleep, terrifying dreams from which they awoke tense, sweating and trembling. They told of attacks of panic, feelings that they were choking or suffocating, certain they were going to die. Many were depressed; sadness characterised their feelings, their mental and physical activities were slowed up, they felt withdrawn from the outside world. Their facial expressions were mournful and pathetic, they told of loss of appetite, loss of weight, early waking, gloomy preoccupations. They had lost the capacity to care about themselves or those they loved. Many were in the depths of despair and spoke of suicide if they had not already attempted it.

  As I became acquainted with those desperate for the relief the short session with Toby might bring them, I became ashamed of my earlier flippant attitude. Here was a section of the population in urgent need of help. We had been but briefly introduced to it in the days when I was a medical student. During my years in general practice I had been scarcely aware of its existence. They loved Toby. They came eagerly and left dragging their feet.

  Our last patient could have been Fred. His predilection was for long hair and purple but this one had forgotten to wash.

  As far as I was concerned the interview might have taken place in Japanese but Toby was not the least perturbed. The young man, at least I think it was a man, came in demanding the “deep sleep”. He spoke of “speed”, “horse” and Muswell Hill. He admitted to “main-lining”, having graduated from “skin-popping” and asked Toby if he happened to have a “buzz”. I had one in my head as I strove to understand what it was he was talking about and wondered whether something radical had been omitted from my education.

  When he had gone, putting, as they all had done, his faith in Toby, Toby put away his pen and said: “It gets worse and worse.”

  “Oh quite.”

  “We do what we can. It isn’t easy.”

  Light suddenly dawned. “Drugs!” I said.

  Toby looked at me speculatively.

  “See you next week?”

  I agreed.

  “There’s a meeting on Thursday. Various aspects of Psychological Medicine. You’re very welcome.”

  “I’ll try.”

  He thrust a paper in my hand. “I hope the oil’s arrived. Betty will be hopping. I always forget. Must dash.”

  He disappeared, and I walked out slowly past the patients whom there hadn’t been time to see and would soon go home. They looked at me blankly. The Staff-Nurse and the secretaries ignored me.

  The afternoon had been expensive: taxis to and from the car-park, three hours in the car-park, a quid I guessed I would never see again for the Professor’s silver wedding. Something that Toby had said reiterated itself in my head: “…to cure sometimes, to relieve often, to comfort always.”

  I think it was the most fascinating afternoon I had spent in my life.

  Five

  “They let you out, man,” Fred said from where he was reclining on the sofa in my sitting-room.

  I looked at him uncomprehendingly, wishing he wouldn’t help himself to my liquorice allsorts for which I had an uncontrollable passion and which I usually managed to keep hidden, especially from the twins who would polish off anything that happened to be going, regardless of mine or thine.

  “How do you mean ‘let me out’?”

  He selected the black roll with the white middle, my particular favourite.

  “From the bin, drop-out.”

  “If you mean the department of Psychological Medicine…”

  “As you say, wild one.”

  “It’s not some circus. We merely deal with that aspect of medicine which is concerned with the mental element in health and sickness, including mental illness and abnormality.”

  “Balls, man.”

  “I beg your pardon.”

  “Granted.”

  “Psychiatry…” He took what as children we had always called “worm-cakes” from the packet, the round sort covered with tiny blue or pink bobbles, and put it back in disgust. I didn’t like them either. “…pigshit.”

  I glanced round nervously to make sure Sylvia wasn’t within earshot.

  “The implications of psychological medicine,” I said, snatching away the liquorice allsort box in the bottom of which one or two rejects rattled loosely, “when regarded as a field of human knowledge is of supreme importance to practising doctors…”

  “You treating the doctors, man?”

  “…I hadn’t finished. I was about to include patients and the public in general. The doctor’s job is concerned with the restoration of health and happiness to a sick person, and the prevention of ill health or unhappiness among those who are well. Right?”

  “Right.”

  “The psychiatrist, as a doctor with a particular interest in the emotional and mental on the body-mind problem deals with human existence as a whole.”

  “Pigshit.”

  “Fred, sometimes I think you are a bore. A narrow-minded, uneducated bore.”

  He stood up and assumed his favourite position against the mantelpiece.

  “Listen, Dutch uncle, have you ever set foot inside a bin?”

  I declined to answer for I had not.

  “Are you aware, man, of the reams of verse, volumes of prose, paintings, drawings, modellings of extraordinary power and beauty that are produced in these establishments? These writings and paintings, man, convey experiences in the emotional life of patients which are derived directly from the deeper conflicts and frustrations which you are setting yourself up to remove.”

  “Come now, I’ve only done one afternoon’s clinical assistantship during which I never even opened my mouth.”

  “Answer me this, though, man,” he said, ignoring my comment. “Where would we be if they’d put Leonardo in the bin, given Shakespeare ECT or Dickens antidepressants? Kill the conflict and you castrate the artist. Beddoes, Blake, Boswell, Bunyan, Burns, Chatterton, Clare, Coleridge, Collins, Cowper, Crabbe, De Quincey, Dickens, Donne, Gray, Johnson, Lamb, Rossetti, Ruskin, Shelley, Smart, Swift, Swinburne, Tennyson…mentally unbalanced, every freak of them! What about Baudelaire, Dostoevsky, Flaubert, Goethe, Gogol, Nietsche, Poe, Rimbaud, Rousseau, Strindberg…”

  Had I called him uneducated?

  “…Swedenborg, Verlaine… I can’t think of any more at the moment.”

  “You’ve made your point.” I forgave him for the liquorice allsorts. “But are we not to help the man in the street? Mr Brown who can’t sleep…”

  “Dr Johnson couldn’t sleep.”

  “Mr Jones who is depressed…”

  “Dickens was depressed. Put him in an institution and feed him tranquillisers every time he moaned and there’d be no Nicholas Nickleby, no Oliver Twist, no Tale of Two Cities, no Pickwick Papers…”

  Uneducated: Fred!

  “…these people, man, were suffering from the same tremendous emotional tensions people suffer from today. We haven’t just invented them, man. They didn’t sit on their bums in Psychological Medicine though, or lie on analysts’ couches five days a week at five guineas a throw, they didn’t run to the doctor or the priest, they stayed home to paint, or sculpt, or write, or compose with varying degrees of talent. Sometimes their tensions were discharged through channels which were not only creative but almost intolerably moving and inspiring. We have a name for it, man, genius. Psychiatric Assistant! You are helping, man, to run a genius abortion clinic! Don’t take away their te
nsions and frustrations, man; channel them.”

  Speechless I handed back to Fred what remained of the liquorice allsorts. Overwhelmed by what he had said I was unable from my own non-existent knowledge of the subject to answer. I did not bother to tell him that in one afternoon we had managed to persuade Mr Flipping that life was after all worth living; assured Mrs Nuttall that she would in time be able to leave her house alone, free of her fear of crossing the road; helped Mr Callard on the way to achieving a satisfactory heterosexual relationship; for which all three were profoundly grateful. I would have to speak to Toby on the subject before I was qualified to cross swords with Fred.

  “We had one pusher,” I said, guessing he might be interested.

  As usual Fred knew what was going on in the world. “Dagenham, Muswell Hill or Piccadilly?” he said.

  “Muswell Hill. He wanted the deep sleep.”

  “Wasting your time, man. Wasting your time and the strained resources of Auntie Health Service. Horse?” he asked.

  I nodded. I too could speak the language.

  “Powder or ampoules?”

  “Powder.”

  “Not Muswell Hill, man. Powdered horse, for your information, can only be obtained from criminal sources. No powdered H from Muswell Hill, man.”

  I wondered if there was anything he didn’t know. There was.

  Lulu came in and said Mrs Smith’s baby had wind.

  I raised an eyebrow at Fred.

  “Taking its feeds too slowly,” he said portentously. “Tell her to make a bigger hole in the teat.”

  “The baby,” I said, getting a small part of my own back for the treatise on Baudelaire, Dickens and Co., “happens to be breast fed. Tell Mrs Smith to bring him round at six and I’ll discuss it with her.”

  Lulu dropped the fur lashes over the sapphire eyes and went pathetically from the room as she always did when the problem was a baby, making her feel her own lack more acutely.

  I raised the other eyebrow questioningly at Fred who was watching her.

  “Mistakes the desire for fecundity for a desire for maternity. She’d be hopeless as a mother,” Fred said.

  “Fred,” I said, “you are an enigma…”

  “Long words for so early in the day.”

  “…I haven’t quite got the hang of you.”

  “Wasting your time, man.” He flung the empty allsort box into the empty grate, he had finished the lot, “worm-cakes” and all. “Try again when you’ve done more sessions in that little old bin of yours. You’ll be full of it then, man; Freud, Jung, Adler, not to mention Melanie Klein and Fromm. You’ll have super-egos and ids coming out of your ears, man, and penis envy, paranoia and Pavlov for breakfast. But you still won’t know a thing about people, man. You still won’t know a thing.”

  Fred went home to change his shirt for one of a different colour before the evening surgery, he never did two consecutive surgeries in the same outfit, and I pondered on the new generation the world had spewed up. The gap in years between Fred and myself was not all that immense, but in perception and values it seemed like centuries. His generation, I had noticed, seemed to be such good all-rounders. Perhaps it was because of communications and the fact that the world in consequence had shrunk. He knew what was going on and not just in the tight little pocket of existence in which he himself had been brought up. He knew, and what’s more he cared, about the Vietnamese and legalised pot and abortion. He knew and he cared about the minds of the sleeping masses, political activism and air-bases which must be reclaimed for peace. He advocated the acceptance of the hip-scene into the normal pattern of life.

  If he had done anything else he had made me think. He had also affected Sylvia and the children. Peter refused, point-blank, to have his hair cut, saying he was growing it like Fred’s, and Penny at breakfast that morning had demanded that I “pass the cornflakes, man”.

  I had promised Sylvia that evening, while it was still light, to visit our new house. Not that it was our house, but the prototype already erected and furnished by a foremost interior decorator as a show-house, with the object of inspiring mugs like ourselves to pledge our all for the others as yet not built.

  I had fought to the last ditch. I liked our present house. Sylvia carried on about the gables and butler’s pantry. It was of sentimental value – our first married home. Sylvia said she supposed I was prepared to stay in the same rut for the rest of my life. I didn’t think it was such a bad rut and told her; she was not impressed. How were the patients going to manage with the knowledge of the fact that I was no longer living on the premises? I played my trump card. The practice, I declared, would fade away.

  “Nonsense,” Sylvia said. “Just think of the peace and quiet. Nobody coming to ring the bell after surgery hours with stupid requests.”

  “I rather like it.”

  “Just when you’re climbing into bed?”

  “It’s not so bad.”

  “Appearing on the doorstep fainting or bleeding when you’re in the bath.”

  “Somebody has to see them.”

  “Well, Fred can. We’ve done our bit. Besides which you’re an absolute hypocrite. You’ve done nothing but moan for years and years now about the nuisance of people knocking you up at all hours of the night and day just because you happen to live here, when they could very well wait until surgery time, and now when I’ve made all the arrangements to save you from it you pretend you’ve enjoyed every minute.”

  “Well, I don’t like change.”

  It was true. It had always been Sylvia who had led me to make innovations in my life. When first we had married I had only on one occasion been further than Frinton for my holidays. My mother lived there, and besides I liked the sand. I had, I rather think, even had the temerity to suggest it for our honeymoon. It was Sylvia who had, over the years, taken me, be it ever so persuasively, to many a remote corner of Western Europe, deaf to my promises that both I and the children would return, if return we did, with cholera and worse, as well as to the breathtaking beauty spots of Scotland, Ireland and Wales. It was Sylvia who prised the clothes off my very back and gave them to Oxfam so that I was forced to buy new ones, Sylvia who persuaded me that my auroscope in its half a case was a disgrace to the profession, Sylvia who installed an intercommunications system in the house when I had been convinced it was more convenient to shout.

  Moving, actually moving, after so many years was the most radical change of all. I was sure I could not go through with it. Without Sylvia I would never have.

  “What’s this place called?” I asked as we drove westwards. After a busy surgery in which Fred had seen precisely one patient, the reason for which I had not yet had time to discover, while I had ploughed through thirty-seven, and a skimped dinner because Sylvia had almost made me choke every mouthful down so that we were able to get out while the light held, I was not in the best of moods.

  “Church Row Estate.”

  “Estate!”

  “‘Superior Town Houses in Country Quiet Setting’.”

  “Sylvia, you know very well there’s no country round here within miles.”

  “I didn’t say there was. It just says ‘country quiet’. It also says” – she read from the particulars – “‘Church Row Estate is one of London’s premier residential developments and its unrivalled amenities and supplements to gracious modern living give it a style which for generations has been associated with Mayfair.’”

  “Whoever wrote that,” I said, turning a corner nastily, “has more than earned his salary.”

  “I haven’t finished. ‘This particular project represents not only an extension of the success of small schemes for Town Houses but the confident use for the benefit of purchasers of the experience involved.’”

  “What exactly does that mean?”

  “‘Situated close to St Saviour’s Church…’”

  “Sylvia, bloody church bells, night and day…”

  “‘…these houses, which are a breakthrough in design, incl
ude the following noteworthy features and advantages: Peaceful surroundings…’”

  “What about the church bells?”

  “‘… and garden views…’”

  “What do you mean ‘garden views’? Hasn’t it got a garden?”

  “Well, not exactly of its own…”

  I took my foot off the accelerator.

  “I mean, well, it has, as I told you, a sort of patio, then there’s this public garden…”

  “Public!”

  “Well, not completely public, actually it’s private, just for the tenants of the houses and the block of flats…”

  I shut my eyes.

  “‘…garden views in a situation nonetheless with fast direct access to the City and Cultural centre of the West End. The considerable adaptability of accommodation which, for example, can give purchasers either a house with three bedrooms and a staff/nursery suite or one with four bedrooms and three bathrooms or two top-floor studio rooms, balcony, roof terrace and a boxroom with plumbing for a bathroom.’”

  “I have always wanted to take my bath in a boxroom. What is it, a house or a jigsaw puzzle?”

  “It just means that it’s extremely versatile.”

  “It would have to be for the money they are asking. It would also have to have gold-plated stair-treads.”

  “It hasn’t got that,” Sylvia said as we turned into the building site euphemistically called Church Row Estate, “but it has got a shaver socket in the downstairs loo.”

  “How frightfully useful,” I said, hoping my back-axle would withstand the strain of the hardened upturned earth, “I suppose that’s for when your mother comes to call.”

  “There’s no need to be rude,” Sylvia said, huffily stuffing the PRELIMINARY PARTICULARS into her handbag.

  “The Show House is over there.”

  Six

  “Over there” was what appeared to be the other side of a ploughed field where a single, unbelievably narrow, five-storeyed structure stuck out like a sore thumb. Beside it the skeletons of several other identical structures spread their tentacles. To the right of us was a vast and indescribably ugly block of flats. To the left the stolid structure of St Saviour’s Church looked on the mayhem with reproach.