O
LIVIA WAS RIGHT ABOUT MY FIRST IMPRESSIONS OF PEOPLE
being at sea. But my second impressions, though I say it myself, are often spot on. I had a habit I’d picked up from Gus Galen, who supervised my analytic training. He told me that all he needed to know about a patient could be written down on a postcard. When a course of treatment finished he said he often looked back and saw that everything that had been uncovered could be discerned in what he had noted there. ‘It’s all in how you interpret information,’ he added. ‘It can take years to understand in your head what your gut knows from the start.’
So I do have a record of the next occasion I met Elizabeth Cruikshank since it was after that meeting that I made my notes. I no longer have access to any official files, and anyway I imagine the bulk of my case histories have either long gone through the shredder or are part of a disconnected account on some NHS database. But of my private postcard distillations there are a few I’ve chosen to retain.
Looking now at the card headed ‘Cruikshank, Elizabeth’, I see handwriting which is recognisably mine but bears the marks of someone younger. The letters are more capacious and better
formed, as if my script has shrunk in proportion to my person. Nowadays, I’m conscious that my five feet eleven inches has dwindled, but the worst thing about ageing is not the physical diminishment. My belief that I am equal to ordinary events and encounters is beginning to be eroded. I am apprehensive now over matters that would have been unimaginable to me then: of trains, and timetables, major road junctions and mobile phones; that my plumbing will break down—and my bladder; that I will be locked out of my house; that along with my keys I may lose my mind. And, of course, my presence in the world has always had a touch of the provisional about it.
But then, as it seems to me now, from my present vantage point, I was in the thick of things. It is a commonplace that it is part of life’s tragedy that while it must be lived forwards it can only be understood backwards; but maybe it can only be appreciated backwards as well. In any case, in those days I had some sort of notion that I knew what I was doing. Perhaps without that feeling we can’t survive.
There’s a party game in which someone goes out of the room and those left pick a member of the group whose identity is gradually revealed through answers to the ignorant interlocutor’s questions: If X were a film what film would he or she be? If a book what book? If a colour, car, item of clothing, meal, country, dog, flower, painting…? And so on. I don’t know when it was that I found that this was a handy device for formulating an impression of the person whose essence I was in a sense trying to discern. After a couple of meetings I would jot down, for example, ‘red, ferret, Jane Eyre’, or ‘bulldog, jeep, Ian Fleming’, you get the idea. I used this as a kind of shorthand to myself, a
way of setting in my mind the co-ordinates of the personality I would be sitting with.
The postcard I’m looking at is a little dog-eared and faded but the writing is firm. The comments are few:
Cruikshank, Elizabeth.
Suicide.
Elegant. Guarded.
Attractive voice. Quiet.
Azure blue. Swallow.
A hinterland person.
Beside the word ‘Swallow’ the initials ‘JA’ have been crossed out.
Another lesson I learned from Gus was to ask, ‘What do I want to do with this patient?’ Not, as he was at pains to point out,
should
or
may
I do, or even can I do, but what, in a world without consequences, do I
want
to do? In theory, this could produce some disturbing answers, though the number of shrinks who actually want to have sex with their patients is fewer than you might imagine. But it’s not unusual to want to hold or hug or touch the hand or shoulder of those we feel for, even in circumstances where to feel for another’s pain is not an inherent part of what is expected of us. Most doctors, if they permitted themselves, would admit to those normal, everyday human impulses which the nature of the work obliges us in practice to check.
Such inclinations take more intangible forms, too. At that time, Jane Austen was my staple reading, a bulwark, I dare say, against my more disturbing professional encounters. For me to think of someone as a character in Jane Austen was a compliment.
But, truth to tell, psychiatric patients are not really Jane Austen people. The Austen world has its quota of narcissists, hypochondriacs, low-grade psychotics and the marginally depressed. But none would fetch up in a psychiatric unit. What the postcard, with the crossed-out initials of my favourite novelist, reveals to me now is that here was someone who, from the first, counted for me, and counted enough that I associated her with my own inner world.
My room at St Christopher’s was a pleasant one, overlooking the back garden, and the chairs were arranged to ensure a view both for myself and my patients. In my mind’s eye, I see Elizabeth Cruikshank, looking out at a quince tree. This tree was a refugee from the days when this part of the hospital was a substantial private house, with the kind of garden that included orchards and well-stocked herbaceous borders. Most of this land had been sold off and was now taken up by the blocks of flats surrounding the hospital, whose inhabitants made occasional protesting petitions at being obliged to live cheek by jowl with the mentally disturbed. The beds at the front of the hospital had, by this time, acquired a municipal look: lobelias and scarlet salvias. But where a corner of the original gardens had been annexed, a couple of the old fruit trees had been preserved.
In spring, the quince was lit with a pale pink translucent blossom, but it wasn’t spring when Elizabeth Cruikshank and I met. That autumn the south coast was experiencing unusually foul weather. She arrived regularly and on time, lowered herself, in a way which suggested extreme fragility, into the blue brocade chair which was once my mother’s, and sat, as the wind whipped the branches of the old quince, saying nothing but
staring out at the tree, which seemed to hold for her a persistent fascination.
There are different qualities to silences and in my job you learned to read them, like an old-style weatherman observing skies or an experienced fisherman reading surfaces of water for signs of imminent fish. I, for one, welcomed them. There are few jobs where you are paid to sit quietly and in the silences ideas have come to me which voluble transactions would have scared away. My patient sat wrapped in her invisible mantle to protect the wounds which had brought her to me, while I sat, a little at a distance, at a discreet angle from her, saying nothing too. There was no antagonism in her demeanour. It conveyed only a lack-lustre indifference, as if I was part of the furniture of a cell—a nun’s or prisoner’s—an unregarded bystander to her pensive preoccupation.
I have no accurate recall of the number of meetings the two of us sat like this and I became somewhat used to sitting, at my odd angle, alongside her. Her mute presence did not disturb me, other than through my growing sense of the extent of this uncharted pain.
But one day, when the weather was particularly violent, after staring a while at the tree outside, she volunteered, ‘It could blow down in that wind.’
‘Yes, it might,’ I agreed, trying to conceal any off-putting excitement.
She made no follow-up to this, so after a decent pause I hazarded, ‘Do you feel you might blow down too?’ The grey eyes grazed mine and looked away. ‘Or you mightn’t survive a storm?’
She made a gesture, as if shrugging the invisible protective
mantle closer round her, but we had made some sort of contact so I pressed on.
I first met Gus Galen at the big biennial conference on anxiety and depression. He would probably be either thrown out or not taken on at all by today’s medical faculties. The son of an East End tailor, he was one of those annoying prodigies who won a scholarship to Cambridge at sixteen, read Greats, became a classics don, gave that up and trained as a medic, specialised in neurology and then found he took more interest in the impalpable than the substantive workings of the mind. By the time we met he’d had, I surmised, a fairly raffish past but there was a childlike innocence in him, which shone in his mild, slightly protuberant hazel eyes. These eyes fixed you with a guileless stare which the susceptible found hard to resist. But he also had a talent for making the kind of simple-sounding observation which permanently affects the way you think and feel.
I met him pacing the pavement outside the hotel where the conference was held and which I’d left to stretch my legs and take a breath of air. He had gone outside to smoke one of the dreadful miniature cigars that I was to learn he was never without.
‘Tell me, dear boy,’ he said (everyone was either a ‘dear girl’ or ‘dear boy’ to Gus, unless they were a ‘bitch’ or a ‘baboon’), darting over to catch my arm—he was a big man but with that nimbleness which big men, in defiance of gravity, sometimes display. ‘What did you think of Collier’s paper?’ Steve Collier was a hard-line drugs psychiatrist.
‘I thought it was pretty crude,’ I risked. For all I knew Gus was Collier’s best friend.
‘The man’s a bloody baboon,’ said Gus, and I felt I had passed some test. ‘Fancy a stroll?’
We walked down to the Thames and alongside the greygreen river, then past the Tate and on up towards the Houses of Parliament where we crossed the road to Westminster Abbey.
‘The question,’ Gus said, punching my upper arm in a gesture which I discovered was as much part of him as the disgusting little cheroots, ‘the question is not how to cure or be cured but how to live.’
It was a comment which dropped like a diamond into the well of my being where its simple brilliance never ceased to sparkle for me. The people we were treating were not so much looking for a remedy for anxiety or depression, they were looking for a reason to be alive. For the most part, the human race takes for granted that life if not a blessing is at least desirable enough to cling to. But for those for whom the business of being alive is a much more vexed question, the illness is the question, or, to put it another way, the illness is how the question may be posed.
For these hesitant souls it is life and not death that holds the terrors and if I recognised the feeling it was because I shared it. But it took Gus Galen to put it into words for me.
‘See there,’ he said, stabbing with a burly finger in the direction of the old church, as if he were about to accuse it of some serious misdemeanour, ‘that’s what places like that should be for. To help us live. There’s no cure for being alive…’
‘There’s no cure for being alive,’ I suggested into the autumnal silence to Elizabeth Cruikshank.
‘There is.’
The ginger tomcat, against which I waged war, as it used the garden as a latrine and attacked the garden birds I liked to feed, was balancing nonchalantly on the fence outside. I waited a little longer. I wanted her to say it.
‘There’s death.’
She seemed a lot further from me across the three feet or so of space between us in the room than the cat outside.
‘So you were attempting that cure? Rather a drastic one.’ I allowed the smallest trace of irony into my tone.
Again she shrugged, looking not at me but out at the rain which had begun to drizzle down on the elderly tree.
‘Not to me.’
‘Not unwelcome, maybe, but drastic nonetheless.’
Something about her made me feel that the distinction might be one she would understand, but it produced nothing. I tried a different tack. ‘I gather you’ve decided not to take any further medication while you’re with us.’
‘I prefer not.’
‘I see. Any reason? I should say I shan’t force anything on you but drugs can sometimes help.’ It was in my mind that it was drugs which had failed to help her leave life, so I could appreciate her antipathy to having them help her endure it.
‘I’d rather not.’
‘Fair enough,’ I said, deliberately brisk. ‘Let’s see how you go.’
I waited again in case she came out with anything more and the silence thickened, hovered for a moment, as if she might relegate it a second time, hung in the air between us and then attenuated and passed over. I felt there was no more to come
from her but I made an appointment to see her the following day.
The principal part of the hospital was located in a modern building across the garden from the old house where I had my room. I was about to make my way over there when I heard the unmistakable voice of Lennie, our office cleaner.
Lennie was a recovered schizophrenic. I say ‘recovered’ but more accurately I should say managed. He had stayed on after being brought in for the umpteenth time from under the pier, where he hung out, madder than the vexed sea and covered with sand and pee and some or other form of the more diabolical kind of alcoholic spirit he consumed, and talking wildly to the more other-worldly ‘spirits’ who, on such occasions, invited him to demonstrate his faith in them by committing his body to the deep. I was the duty consultant that night and, I don’t know why, he took to me and I persuaded him that a regular Modecate injection might prove a sensible precaution against the spirits’ more disruptive injunctions.
Lennie took to dropping by my room, where, if I were free, he would stand and smile and I would smile back. As Gus Galen will tell you, there are important conversations which have nothing to do with speech. One day, he pointed at the window which looked out on to the quince, then transfigured by pale pink flowers, and said, ‘You see the blossom better, doc, if I was to wash the window.’ We had problems at the time getting cleaners and, with one of those brain waves which occasionally I act upon, I decided to make an advantage out of the fact that Lennie seemed to want to be useful. The inspiration paid off: Lennie took the job and was by now our longest-standing, and
easily most efficient, cleaner, which arrangement allowed me to ensure that he kept up with his Modecate injections. In turn, he cleaned my office as painstakingly as if it were an emperor’s palace.
He was a bulky man, never to be seen without a yellow woolly bobble hat, which sat, jammed on his black head, atop his six-feet-plus frame, like a baby’s bonnet. He had become a popular figure around the hospital: his disposition was as benign as a baby’s and he had only one enemy, Dr Mackie, who was my enemy too.