I am half way through my final year rotation in general practice and am sitting in
on an afternoon clinic. The GP summarises the next patient's notes for me.
“Okay, this man is 56. . . .Hiswife died at
home five weeks ago of rectal cancer. . . . He
took early retirement. . . . We've got himon
some dothiepin [an antidepressant] . . . he
seems to be taking it all quite badly.”
As the patient sits down, the doctor asks
him what he's been up to over the past week.
He sighs and the tears start as he realises
that he has been filling his time with
nothing, that he has nothing to fill his time with, and
that he is drinking more.
“I can't think of anything that's worth doing.
Everything's so empty and
useless.” He trails off and I
start to remember the feelings that I am just starting
to put behind me. My own
mother's death is distant
enough to no longer be a
constant preoccupation but recent enough
for the emotions to come back at the slightest provocation.
“There are so many little reminders
everywhere. I'm okay most of the time and
then something happens and I remember.”
My dad calls these “triggers.” He talks of
how he must sell the house because it is full
of triggers. How even having an argument
with me will upset him and remind him of
how similar Mum and I were.
“I know I should be filling my time with
something but I don't know what. Perhaps I
should go back to work. But I can't
concentrate. It's like I want
to go back and I don't want
to go back.”
I remember my own
lack of concentration and
confidence. That it didn't
bother me to begin with but
got progressively more frustrating until eventually I was hiding in the
library all day to avoid any clinical contact
and the acute anxiety it would bring.
“I worry that I'm going to do something
stupid.”
Like what? Like take an overdose? When
I finally plucked up the courage to ask my
GP for some help he gave me a prescription
for paroxetine, an antidepressant, and the
standard warning about how long it would
take to work. As I returned from my first trip
to the pharmacy, it occurred to me that if
taking one a day for 14 days would make me
feel better then perhaps taking 14 in one day
would have the same effect—either that or
end things once and for all. And I am
supposed to be sensible. I am sensible. I am
a rational young woman about to qualify in
medicine and yet even I (the invincible) can
be brought to my knees by grief.
“How long will this go on for?”
For ever, I think. You're five weeks in now
and it's still raw and sore. But in five months
you'll still have your bad patches. And five
years from now, when everybody thinks you
must be well and truly over it, you'll still have
those tight throat, fighting back tears
moments. “The first five years are the worst,”
warned Auntie Pat.
“When I'm with my friends it's like I'm
wearing a mask. I can be normal and they
think I'm fine. But I'm not,
I'm just pretending and
when I get home I'm me
again and I'm scared.” I was
able to function perfectly
well at a superficial level
quite rapidly after it had
happened. But it was wrong
and I knew I didn't want to
live like that. I did because I
felt that most people didn't
know how to handle me,
wanted me to be the same but were scared
about how I might have changed.
“This can't be normal, can it? Something's going wrong. What's wrong with
me?”
Nothing. Nothing is wrong with you.
Nothing was wrong with me. It is just an
unknown. The mask that he had mentioned
is what everybody must wear when confronted by grief so that nobody realises how
bad it is until it happens to them. It's normal
to be going through this. It is normal to
think how stupid and inhumane it is that
people, even your best friends, won't, or
can't, talk to you about it.
And after he has dried
his eyes and apologised for
taking up our time, we have
to decide what to do. The
doctor can offer to increase
the dose of dothiepin, to
refer to the practice counsellor, to be available whenever needed. But
all these things feel desperately inadequate.
What this man needs is time to work
through his feelings, a friend and companion who is willing to listen, someone to love
him and hold him when it all gets too much,
someone or something to take his mind off
his preoccupations. He needs the one thing
he hasn't got—his wife. Just like my dad
needed his wife. Just like I needed my
mother.
And once again the frustration of medicine's limitations and humanity's inadequacies hit me and drag me down and I wonder
what all the learning is for if I cannot deal
with this, the commonest of problems.