Friday, 30 September 2011

In Memoriam

This again has its origins in real events, with the details altered and the name of the patient changed to ensure anonymity and confidentiality. It is another in the series "Of Love and Loss". I originally wrote it about eight years ago.

In general practice, the accumulation of years inevitably leads to a steadily growing mental catalogue of personalities whom one has met, sometimes come to know well, and for one reason or another have moved on again - to another county or country or, all too often, away from this mortal coil entirely.

          Kenneth was one of these. He "adopted" me in my green years when I was newly arrived at my practice, over a quarter of a century ago. And while he certainly had the avuncular air about him - with which I felt comfortable enough - he was clearly a vulnerable and wounded man. Relapsing depressive disorder had been a part of his life since his own youth. He was anxious to discover just who had replaced my predecessor in the practice, and anxious to know how I would take to him. We quickly became comfortable with one another. For he was not a "demanding" patient in the sense that we GPs tend to use the word. Appointments never went over their time. He seemed happy enough to know that I would continue to see him once a month for an update, a chat about things in general, and his repeat prescription. At that time he was on a monoamine oxidase inhibitor, sticking to the prescribed regime obdurately in the manner that slightly obsessive people tend to do. "Ah, it’s Kenneth next" I would murmur to myself with a sense of relief when I was tired or running a little late. For I knew that, if the occasion required it, he would not delay with me. "I can see you’ve had a busy afternoon, doctor."

          He learned very quickly that I had a young family. "What they need, of course, doctor, is plenty of fresh vegetables". And he left a bag of the most delectable purple sprouting broccoli from his allotment, at the reception desk the next day for me. I don’t think the children were quite into the brassicae in those days, but that night my wife and I feasted upon it.

          "Do you enjoy gardening, doctor?" he enquired the next time he called. I told him I was something of a novice, but yes, I did enjoy it. But our garden, being in the city, could only cope with a modest display of annuals. I was a potato and tomato man myself, but space simply did not permit it. I don’t think "grow bags" had arrived at that time. And that was the gist of our conversation.

          "What about an allotment?" He asked next time. I told him that I would love one, but in those days there was something of an allotment craze, and the waiting lists could be years long. "Don’t worry about that, doctor. I’m on the Committee!"

          A month later he was helping me to dig the couch grass out of my newly acquired patch, leased to me at a rental of about £3.50 a year.

          Life got busier with the children growing and the increasing professional demands. I had taken up postgraduate teaching by then, with its inevitable intrusion into my time away from the surgery. Kenneth said to me "You need to watch out, doctor" and went on to enlarge "I see your ground’s not looking its best. Could be a problem there." I agreed, sheepishly. "Problem is, doctor, the women". I did not understand what he was on about. "It’s women - on the committee! Cor, they want the whole site to look like it’s been manicured!" He did what he could to help me. But things went from bad to worse, and one August we returned from a holiday to find that it had been "requisitioned" as Kenneth put it, by a fit retired couple with plenty of time on their hands. I never saw it looking so pristine. But the soul had gone out of it, I thought.

          This unfortunate turn of events coincided with a deterioration in Kenneth’s health. He developed a bowel problem which worried me a bit and him a lot more. I told him I’d like him to see a specialist. I don’t think I fully appreciated the anxiety this suggestion provoked in him. At his appointment he was told he would have to have a barium enema, for this was in the days before lower intestinal tract endoscopy was the almost routine matter that it is now. He was terrified at the prospect. Not the thought of the procedure itself, but by the horror of the notion that it might cause him to be incontinent when he got home, and soil the carpet. He was not to be reassured. He quickly relapsed into profound depression, so profound that I feared that he might go so far as to make an attempt on his life. The bowel problem was put on one side, and an urgent psychiatric referral set in motion.

          "Do you think they’ll give me the electric shock treatment, doctor?" He was utterly changed from the man who had helped me weed and sow on those sunny evenings the previous spring. "I do hope they will. It really brought me through the last time ..."

          All this took place at a time when electro-convulsive therapy had slipped from favour. Pressure groups claiming to champion the "victims" of psychiatrists were in the ascendance. Doctors had been sued.

          His appointment came through very quickly, to our mutual relief. But when he saw me the next day he was in a state of near despair. "They say they don’t do it now. They want me to start some different tablets".

          The following morning, when I was away at a conference, one of my partners was called to the block of flats where Kenneth had lived to certify him dead. "He was very dead" she assured me, visibly shocked, that afternoon. "His brains were splattered all over the floor of the basement."

          The Coroner said that because it could not be certain that he had intentionally thrown himself down the stairwell from his fifth floor flat, he would record a verdict of accidental death. His wife was grateful and relieved about that. But I did wonder, as I have often wondered since, if we really do have an accurate idea of the incidence of suicide, and whether the denial of what is pretty self evident really serves to help people with mental illness. It is certainly clear that it provides a modicum of comfort for their grieving families.

          From time to time I am called to that same block on visits to other patients. The heavy steel hand rail on the stair case at the ground floor still bears the concavity where Kenneth’s head made its final and catastrophic impact with it, and cascaded its contents on to the floor below. And I think of his honest, gnarled hands as he helped me to lift the first crop of new potatoes from the good earth on a warm summer evening twenty years ago. And I think of all the things he did for me, and of all the things I was never able to do for him.

Monday, 26 September 2011

The Beachcomber

This is my first story in a series entitled "On Love and Loss". Elements of it are based upon real events. I did indeed gather ancient bones when I was a boy from the bottom of an eroding cliff at Dunwich in Suffolk. And my father did have a visit from the police some months after we had moved from a property which was demolished by developers. His life was blighted by grief, not for me as I survived him, unlike Miko, but for my mother and my stepmother.

The Beachcomber

Two police officers stood at the front door. Some questions about where I had lived before moving in to the flat. And then, with appropriate gravity, “We have to inform you sir, that human remains have been found at that property.”

I was thrown by the announcement. In my initial confusion I found my mind racing back to happier times. When my son was preoccupied with the adventure of growing up, and his mother still my wife. He now irrevocably lost to me; she also lost to me, having sought solace, and finding disillusionment, with another man even while we still lived under the same roof.

I was shocked, and frightened. Were they accusing me? Would I be spending tonight and many more to come in a police cell on suspicion of murder?

“Are you able to account for them?”

Of course I could account for them. I knew at once the significance of their discovery, and wondered how I could have been so careless. Our leaving the house that had been home, a contented home to our small family, had been precipitate. It held too many memories, which could only sustain a grief that was almost impossible to bear. Even then Mary and I had started to bicker and on at least one occasion had had a furious row, over nothing very much in particular. I know now that this had more to do with our suppressed rage at our loss rather than anything seriously wrong between us. And a sense of shared guilt which I know now was groundless. Yet we were almost consumed by it.

Michael … Miko, you were my only son, my only child. And I adored you. What might you have become had had you not gone? Every parent sees their child as exceptional, but there surely was something quite unique about you. Not just the driving curiosity common to all young children, but the sheer joy you experienced in your discoveries. You were a hunter after things to fire your imagination, and your imagination fired further your desire to seek out yet more wonders in the world where you found yourself. You of the grimy knees, the scuffed shoes, unkempt hair and perpetual grin. Yet you were quite without guile. You were a respecter of wild things and their habitats, although there was little enough that they could keep secret from you. Fossil hunter and star gazer you were. And an avid beachcomber on our occasional holidays by the sea.

I hear his voice even as I think about him. “Dad, Dad! What’s this? It looks like a baby shark!” He had run to me clutching a dogfish, pretty much intact and only recently dead,  judging by the absence of stink. He insisted on taking it home. “I’ve seen fish pickled in jars in the museum. Couldn’t we do that?” I warned him of what his mother might think, but he was not dissuaded. At a hardware store on the way home we bought a quantity of methylated spirit under the suspicious eye of the brown-coated shop keeper. An hour later the creature was consigned to an old sweet jar, suspended incongruously in purple preservative, and placed with pride on the mantelpiece in the boy’s room.

He was drawn to the sea and the sea shore. Even the days in high summer were not long enough to satisfy his desire to seek out exotic treasures in the shingle and the flotsam cast up by the previous winter’s gales. On two or three occasions we gathered driftwood and lit fires in a roughly constructed hearth of stones. Sausages cooked in a cheap frying pan, fresh bread and tomato sauce we feasted upon. I see Michael’s ketchup smeared face split by his grin, and in my imagination I ruffle his hair again. No queen or king ever delighted in such banquets as we tasted then.

Back home he arranged his treasures haphazardly in seed boxes and placed them on roughly constructed shelves in the redundant hen-house. Outside he hung a sign “Michael’s Miniature Museum”. Friends and visiting family would be taken there for a tour of his exhibits. Not all shared his enthusiasm, but this invoked little more than pity in the boy. “Dad, they just don’t see” he once said to me in a tone of exasperation.

I saw his point - and theirs. Not many shared his enthusiasm for abandoned birds’ nests, the bunch of porcupine quills given to him by a keeper at the zoo, and his prized dogfish. But his collection was essentially for his own enjoyment and it seemed that he thought little of other people’s views on it. As the months went by it became clear that finding a space for everything was going to be a problem. And it was equally clear that any sort of a “cull” was not an option for consideration. I noticed, however, that with the passage of time he did become more selective about what he picked up.

The last summer that I shared with him was what I guess was something of a pinnacle for the boy. We rented a cottage on a remote part of the Suffolk coast, close to one of its wide estuaries. Desolate and wind whipped, it clearly appealed to something deep within Michael’s heart. I never saw him so happy. He did his homework too. “Did you know, Dad, that a whole town was washed into the sea just here?” he told me as we walked at the foot of a low, sandy cliff. “They say that on some nights you can still hear the church bells ringing deep under the water!” His mother put her foot down at his suggestion that we might camp out there so that we could experience the ghostly tolling for ourselves.

“You could get swept away by the tide in your sleep” she cautioned. He did not press the matter. For he had also learned that the coastal erosion was still very much ongoing. Yet he seemed content enough to occupy himself pretty much entirely with his searching among the sea wrack for whatever might lurk beneath the glistening fronds. This year, too, he became more inclined to wander off on his own, always promising his anxious mother that he would not go so far as to lose sight of us or we of him. The fact that he showed fewer of his discoveries to us caused us less concern. With hindsight it may well have been that we were remiss in showing less interest than we might have done. But this was all in the days before contamination with used syringes and other unsavoury human detritus had begun to blight our shorelines.

I did not discover the full extent of his collection until early in the next year, when I was able to steel myself to go through his things.

“Sir?” one of the officers jerked me out of my reverie. “Are you O.K? It’s not as if we’d suspected … the pathologist said that the bones are very, very old.”

I nodded. “Yes, I know they are. Hundreds of years old.”

“Much older than the house even. Seems that they were put there. In a box, under the stairs. So you know about them?”

With relief I realised that the police officers were not, after all, making any sort of criminal enquiry. Perhaps they already had a pretty good idea of how the remains had come to be there and just wanted confirmation.

I nodded “Five years ago  … we, my son and his mother and I … we were staying near the east coast. It’s a part that gets hammered by the gales in the winter. I’m told that the waves smash into the cliffs when the tides are high. They’re soft, and several feet get cut away each year …”

I recalled the conversation I’d had with a local, a retired coastguard from a nearby town. He told me how some years earlier the erosion reached the edge of the grounds of a long ruined monastery, encroaching at last upon the burial ground of the monks who had lived and worked there. It seemed that the sea was no respecter of the dead. In the wake of every onslaught was a scattering of bones across the shore. When he found them I think Michael must have realised what they were and could not resist taking such as he came across and adding them quietly to his other trophies. But I did regret his not telling his mother and me what he had done. It was never in his nature to be secretive.

“We thought that might be the way of it, sir. Probably best if you have a quiet word with your lad some time. This has taken up some police time that could have been better used …”

“Of course. I’m sorry. I’ll have a word with him … later today.”

They took their leave and left me to my thoughts, and the lonely evening that lay ahead of me. At last I put on my coat and set out on the familiar route to the cemetery. Ten minutes later I was standing by the grave. “Well now, Miko … would you ever guess who came to see me today?”