Jack & Gill Windmills on Pilgrim’s Way
It was one of those very English June days when daylight seemed to last forever and when everything looked so green and lush that the only thing to do after work was to play golf and perhaps have a late dinner.
We had a rather small but delightful 18-hole golf course in our village, Hassocks Golf Club, and you could see the Jack and Jill Windmills from several vantage points. The most interesting hole was Hole 11, which involved hitting the ball across a small pond. It was a Par 5 hole and the fairway doglegged to the right so that you could not see the green from the Tee. I was a beginner and had just completed a second course of lessons. As such, I would have been very happy to get the ball over the water from the tee, land it somewhere on the marshland and then attempt to reach the green from there in two shots. When you played after a few rainy days, sometimes your ball might sink into the mud and disappear, and unless you could remember where it landed you would never be able to find it again!
Golf is challenging in the sense that the game requires the player to be able to do several things right at the same time, in order not to get into any serious trouble. I have always maintained that for this reason golf is in fact a brain work-out. Think putting: the brain needs to read the break, speed of the grass, and the impact of the putter. With any luck the ball then goes in or gets within 6 inches of the hole. For that, the brain has to marshal much motor memory and computation power. Watching the likes of Tiger Woods and Phil Mickelson make the mistake of changing putters at the last minute only to get horrendous results was to me good evidence of this. It is vital to get the computer that is the human brain working on the green!
To tell you the truth, I had not played for weeks. Since we moved on to full capacity at the adolescent inpatient unit, dinner was late most days, and golf never even crossed my mind.
Not long ago, Kate was admitted on a Section 1361.
Section 136! A very rare occurrence and certainly my first with an adolescent.
Now she was so much better that I signed her off for an afternoon leave to go horse-riding with her sister. She had not been on her favourite horse for as long as I had not been on the golf course.
“If she could have fun, so could I.” I told myself.
I was playing on my own, following and trying hard to keep up with Tommy, one of the well-known members of our club. Though he was eighty three, in the summer he would play two rounds every week-day. He was still as sharp as anyone could be and could reel off details of many famous major tournaments, who won, scores and all. Tommy gave us hope for our old age and perhaps also signs of golf being good in preventing Alzheimer!
He was just ahead of me on the course, and had no problem with Hole 11.
As I was about to Tee off, my mobile phone vibrated. I knew I should have switched it off, but being a consultant who covered two inpatient units, I had to be contactable 24/7. The course was not busy anyway and I was not disturbing anyone. My friend was already on the green putting.
The call was of course from the hospital. I knew it had to be the adolescent unit.
"Kate fell off her horse! Her sister just called. The helicopter should be there soon. Some mountain bikers scared her horse."
Not many weeks before on a small country lane in our county, some truck tried to negotiate a corner and hit a young girl on a horse. My own GP was called out to the scene and it was so traumatic for him that he had been on sick leave for a while.
I mumbled to myself, “don't let me lose this one!”
My patient, not the golf ball.
"Where?" I asked, hoping it was not the same country lane where the recent accident occurred.
"Oh. Pilgrims Way."
Just by the windmills. I was vaguely thankful it was not the same fatal country lane.
"Yes, I can hear the helicopter now."
Well, that was my golf for the day.
It was just over six weeks previously when I received a call from the adolescent unit. Most times when we had an admission, the junior doctor on call would first deal with all the admission procedures, carry out the mental and physical examinations and, if necessary, call me for any advice.
The charge nurse had already turned up and with his years of experience, he was quite on top of most things. So, if he asked me to turn up, I complied!
"I thought you might want to see the parents of this patient. They are rather upset as their daughter was in a police cell and then put on Section 136."
"I will be there!"
When I arrived I saw this Daimler Double-Six in the car park.
“Must be the parents of the Section 136.”
A mismatch: Daimler and Section 136!
I myself used to own a six-cylinder Daimler, having acquired it second hand from the father of a doctor friend when I went back to Hong Kong for my sabbatical year. They were a family of five doctors, father and four sons. The Daimler was such a good riding car that at the end of the year, I had it shipped to England. Double-six was the vehicle with the twelve cylinder engine.
I decided not to talk about the car on this occasion. We had a serious clinical situation on our hands.
Kate failed to return home that evening, and an hour or so after midnight the parents decided to call the police.
She had been with some friends in the coastal town and then she was left on her own when the rest went home. After wandering around for a bit, she tried to board a train without a ticket. That got her into an argument with the guard and she started to hit him. It must have been a shock for the guard as she spoke with a very posh accent.
The guard tried to get her to sit and wait in the waiting room, but she became progressively more incoherent and that was when he decided to call the police.
"First thing she told us when we saw her at the police station was that she had sex with a vagabond on the beach." Mum whimpered.
"I will sleep with anyone I like!” She shouted.
“It was so distressing! What if she got Aids?" Mum broke down crying.
Was this just rebelliousness or was it to do with alcohol or drugs?
"She cannot stand alcohol and she has never really tried drugs."
Paradoxically, it is more worrying when outwardly bad or mad behaviour has nothing to do with drugs or alcohol.
A child psychiatrist should not wish for alcohol or drug to be the cause of the problems of our teenagers. However, the saving grace of that scenario is that the teenager concerned is not really suffering from anything more sinister in psychiatric terms. On the other hand, it is possible that drug and alcohol may indeed be self-medication for a psychotic breakdown.
What I was next told was not really something I wanted to hear.
Father ran a very successful shipping insurance company and mother was the head of the mathematics department at a top girl’s school. Their nice big country house was very near to where I lived. It was part of a bigger farm, but the owner sold them the main house together with some farm land, where they kept a few horses for riding.
They had an older son who was a high flier and was a successful management consultant. Cocaine and other drugs eventually got the better of him and he had been in and out of rehab.
“That is why Kate would not touch any drug.”
“Annabel, our second child, went to Oxford to study anthropology but attempted suicide twice in her second year. She never completed her degree and we have built a separate cottage at the gate for her. Unfortunately she turned to alcohol and went through the alcohol addiction programme a few times at a premier rehab centre in Kent. Not quite the same as the one her brother tried. She is good on the horse when she is not drunk.”
“That is why Kate would not drink.”
"You see, I do not get it! I am not boasting, but all my children can have whatever they want and yet they just....... and look at Kate now......What did we do wrong? Best of everything: skiing, cruises, safaris and diving. Best education money can buy, good cars and good designer stuff…" The father clearly felt lost, very puzzled and frustrated.
From my recent excursions, I did notice that the crazy rich Asians had also gone for diving in a big way. Parents nowadays tend to go through all hoops to satisfy their offsprings!
"Do you think she really had sex on the beach? What about Aids!" Mum was most anxious.
I assured her that we would send her for testing in due course.
Dr. V was with me and I could see she was trying to hold back her tears. It was gratifying to see she had not yet been hardened to beyond feeling for her patients.
Dr. V later tried to apologise for getting emotional.
“It would be a sad day when we can no longer feel.” I reassured her.
"So do you think we are dealing with Bipolar disorder here?"
I liked her humility.
"Do you think her brother and sister would have done better if they had been put on Lithium?"
Dr. V evidently remembered well our previous discussions on Lithium and Bipolar disorder.
An extremely successful father and two equally brilliant siblings; a strange episode; and irrational behaviour.
“Do a full mental examination and we will see.” I told my star registrar.
The next day, after extracting more history, Dr. V told me that Kate’s sister attempted suicide shortly after being put on one of the newer SSRIs.
"We will not put Kate on one of those. Do you know what to put her on?”
"Lithium!"
We had another meeting and this time only mother turned up. Father had to fly to New York for his work.
I explained to mother Kate's condition and our plan. Our plan was to start her on Lithium and virtually nothing else, despite some depression like symptoms.
We did not want to push the level up too quickly and we had to monitor her blood level.
The adolescent unit, to give its due, managed to care for Kate without having to resort to any other medication. Good nursing is crucial in young people's psychiatric care. They need the experience and the confidence to be able to keep an eye without being over intrusive, which is quite a difficult balance; but there are advantages for such a unit to be government run where money never comes into play.
“The nurses seem to know you do not like to use sedating medication. Doesn’t that make their job more difficult?” Dr. V asked me
“They were quick to grasp that it was my preferred way and I had good reasons. Without the habitual prescription of tranquilisers, we are able to assess a patient in the raw. It is not my primary job to make life easy for the nurses, and in many ways I am proud that they have risen to the challenge. Of course the success of a few quite dramatic cases have helped to win them over!”
Mother said to us, “I know it may sound silly, but what I see here is much better than the expensive places my other two went to. So I have complete faith in what you might be able to do.”
Facilities wise, we had nothing to write home about. The unit was housed in a hospital typical of the worst of the modern 70s one-story flimsy quick-build kind. The male and female wings were separated by a central area flanked by the school on one side and the medical unit on the other. This was no Victorian beauty like the Children’s Unit that I also had to take over at very short notice. That stately building used to be the house of the medical superintendent of the old mental hospital.
It was how the staff were able to handle Kate that impressed mother. She knew we were not the Ritz. We never pretended we were. But we were able to calm Kate without turning to medication.
"How long will we have to wait?"
I looked at my registrar; this was a test for her, the future child psychiatrist.
"I have feedback from other patients that somehow the brain becomes clear after three or four weeks. I do not think it would be before three and the longest would probably be six."
How smart and confident of her! I would not have said anything different.
Patients and their parents prefer doctors who know what they are doing and who can manage to impart that confidence convincingly.
Without a single doubt, mother had entrusted her daughter to us. She expected us to deliver, and we must.
When we practise real medicine, independent of influence of big Pharmas, our only concern is the patient's recovery, which is satisfying when achieved.
One late morning I drove into the adolescent inpatient unit car park and saw the gleaming Daimler. Kate’s parents were there.
I saw Dr. V as I entered.
“Trouble?”
"Have faith!”
“Kate has done it! She told me that the blur had cleared. She could not remember what happened but she just wanted to get better and go back to school and ride her horse again. The parents came in as they wanted to thank you personally. You've done it"
"No, WE, we've done it! All of us!"
I cannot help getting emotional even as I write it now, and say a silent “thank you” to my Australian colleague and to Cade.
It has made practising medicine worth its while.
As I loaded the golf clubs into the boot of the car, another call came through.
"Kate was fine: no broken bones. They are keeping her overnight for concussion observation."
“Thanks!”
Dr. V sat her Membership exam and passed it first time, as I expected.
The parents came to see us some time after Kate's trial discharge.
This time I said: “Love that Daimler2! Rides well. I used to own one."
"Less flamboyant than the Rolls. I think the independent chassis is what makes it ride so well!”
“Anyway, thanks a lot. We've got her back and she is back to school and even back on her horse."
As it turned out Kate did not have HIV or any other STD as she did not really have sex with the vagabond. It was an imaginary vagabond.
That was scary though.
Post Script:
I received a card from mother:
“……We are delighted that Lithium has been as successful for Kate as you predicted. She qualified as a riding instructor, passed her A level in English a year early and was predicted to have As in all other subjects this year. She has been offered a place at XYZ University. Oh, most important of all, she started to behave in a balanced and sociable way. (Nearly forgot to mention this because we take it for granted now.) Best etc, etc…..”
The Cockroach Catcher II: Attempted Living---He Did Not Show
The Cockroach Catcher II: Attempted Living---Life is a Beach
The Cockroach Catcher II: Attempted Living---Incestuous Failure
The Cockroach Catcher II: Attempted Living.
Just published on Amazon
The Cockroach Catcher II: Attempted Living.
Review on Amazon:
Reviewed in the United Kingdom 🇬🇧 on January 17, 2023
Reading his memoir is eye opening, and at times therapeutic. It was like meeting up with a learned old friend, as you sit with him and listen while his memories and ideas overflow. You travel with him as his stories move from continent to continent, from detailed episodes to gentle remarks, from freshly harvested catches to gourmet preparations, from ancient finds to modern scientific research ......
A most delightful read.
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