All in the Mind

Professor Martin Sturrock was feeling stressed enough already, even before the phone call from Simon telling him Aunt Jessica had died. Now, as he sat in his office waiting for his first patient of the day to arrive, he felt a rising sense of panic mixing in with the usual Friday tiredness. He tried to quantify the panic. Was it manageable, or did it herald a plunge? Would it fade as the day passed, or was he facing a weekend of angst and insomnia? He thought it was manageable. Just about.

Friday was usually Professor Sturrock’s best day of the week because it was the day he saw David Temple, his favourite patient. But he could not recall a Friday that had started as badly as this one. He had woken up feeling low, a mood not helped when he glimpsed through a gap in the bedroom curtains a grey sky carrying a hint of rain.

Breakfast had been another silent stand-off with his wife Stella, who seemed to find something to be angry or sullen about most mornings, and today chose the fact he had opened a fresh carton of milk ahead of two cartons which had been in the fridge for three days already.

‘I don’t understand why you can’t look at the date on the side,’ she’d said on realising his error. ‘You’re supposed to be the one who likes everything ordered.’

On a good day, if his mood was up and the sun was shining through the kitchen windows, the pouring of fresh milk on to organic cereal could carry with it a sense of hope, vitality and energy for the day to come, whatever challenges it might hold. On a bad day, milk had all the emotional qualities of slurry, especially when his wife was making an issue of it.

He’d had a slight knot in his stomach ever since he woke up, and food was not going down well. The cereal lacked its normal taste and texture, and his coffee tasted burnt and bitter. But with the number of patients he was seeing today, he knew he had to eat. He thought about slicing a couple of bananas into the mix, as they were easily eaten and digested, and a good energy hit. He glanced over to the fruit bowl, sitting on the counter a yard or so from where Stella was rearranging the contents of a cupboard, noisily, for reasons known only to her.

There were plenty of apples, both green and red. There were at least four oranges, maybe more hidden below those he could see. There were a few plums which looked as if they were beginning to go off, and a small bunch of grapes which already had. There were only two bananas, lying on top of the apples, joined together, with the attached ends hanging over the edge of the bowl. But he felt the risk was too great. He might peel them, slice them, start to eat them, and only then would Stella turn from her cupboard rearranging and say, ‘I was planning to have those for breakfast myself.’ So he carried on chewing, telling himself he could buy a couple of bananas from the fruit and veg stall at Brook Green tube station, and eat them when he reached the hospital.

It was while Sturrock was taking his cereal bowl to the sink that the phone rang.

He thought about just allowing it to ring away in the hallway, leaving for the tube and letting Stella decide whether to answer it or not, but the milk-carton incident had left him feeling defensive. He went to pick it up.

Simon and he rarely spoke these days, so the second he heard his cousin say, ‘Hello, Martin, it’s Simon,’ he knew what had happened.

‘Oh dear,’ said Sturrock, the formulaic tones of death already taking over the conversation.

Aunt Jessica was the youngest of three and, Martin’s father having died five years before, the last of that generation of Sturrock siblings to go.

It was different if it was a friend telling you about the death of someone you didn’t know. ‘I’ve been at a funeral,’ a colleague might say. ‘My uncle died.’ ‘I’m sorry to hear that,’ you’d reply, and it would be no more or less than your colleague expected. They’d want you to sympathise but wouldn’t expect you to go over the top about someone you’d never even met. With blood relatives, the death codes were not so simple.

He had been close to his cousin as a child. Though he grew up in Hertfordshire and Simon in Somerset, they had spent all their holidays together, and he had enjoyed many happy weekends staying at his aunt and uncle’s cosy farmhouse with its blue-and-white crockery and worn pine furniture. His father was an engineer, whose work often took him abroad, and his mother thought that a bit of male company in the holidays would be good for him, rather than knocking around the house with her and his sister Jan. Fifteen months apart in age, he and Simon had played together, fought together, complained about their parents to each other, swapped ill-formed and confused fantasies about girls. But though there was kinship there, there was no lasting adult friendship. By the time he was in his mid teens, he had stopped seeing so much of Simon. The allure of trips to Somerset had vanished. Instead, he formed closer bonds with his own school friends, refusing invitations to accompany his aunt and uncle on holiday. And so, slowly, he and his cousin had drifted apart. Where once they would see each other several times a year, as young adults building their own lives, that dwindled to Christmas and Easter and now, as they neared pensionable age, it was usually weddings that brought them together, or funerals, the last of which had been Simon’s father’s.

Sturrock could tell that Simon had already made the call to several others. It was as though he had a script, and he was ticking off the main points.

Passed away peacefully. Something of a release in the end.
Good innings. Sturrock thought it odd that even people who knew nothing about cricket, and possibly had never watched let alone played the game, used this phrase to describe the life of anyone who had lived beyond eighty.
Details of the funeral still to be decided.
Then a couple of details from the last few days, in Aunt Jessica’s case how they knew things weren’t good when she refused blackcurrant crumble on Monday evening, even though it was her favourite pudding, and also the story of a row with one of the nurses at the care home who insisted on her sitting downstairs with the other residents to watch afternoon TV when she actually just wanted to stay in bed.

It was strange to reflect how, in his youth, he really had thought of Aunt Jessica as ‘feisty’. He’d loved her energy, the way she would bustle around the farmhouse, making everyone feel wanted and involved in everything that was going on. He’d loved her cooking and her relaxed approach to mealtimes, bedtimes, and her appreciation of his sometimes unconventional opinions and ambitions. He’d considered it one of the great mysteries of nature that his grandparents had produced two children as different as his father and Aunt Jessica. But then there’d come a moment when he wasn’t sure they were so different after all.

‘I’m glad it was fairly painless when she went, Simon,’ he said. ‘And if there is anything we can do, just call.’ He was conscious of how trite that sounded, then taken aback by the response it provoked.

‘There is something, actually,’ said Simon. ‘I was hoping you might do the eulogy.’

He tried to use his tone of voice to convey opposition to the proposal on several levels. He didn’t want to. He didn’t think he was appropriate. There were plenty of people who were better qualified. He hadn’t seen much of his aunt for the past forty years. He didn’t much like speaking at funerals. He didn’t see why he, a mere nephew, should have to do it, when she had three sons of her own.

But Simon was not good at reading tones of voice. He interpreted the response as one of surprise, but delight and honour to be asked.

‘She was very fond of you, and very proud of what you do, and you would be so much better at it than anyone else. I could do it but I’m worried I’ll break down.’

‘What about the other boys?’ Sturrock asked, boys now with a combined age of 121.

‘Well, Archie and she fell out quite badly over Dad’s will, you remember, and Paul might have a few too many drinks to settle his nerves.’

‘Definitely. I’ll give you all the facts and dates you need and if you could weave in a few nice stories, that would be great. Needn’t be too long. Ten, fifteen minutes?’

Sturrock was losing the will to fight back. He thought it incredibly selfish of Simon to land him with a task like this. But then, perhaps he was the selfish one. Simon had no way of knowing that his cousin was tipping into one of his glooms. Indeed, Simon, in common with his dead mother, would have been very surprised to learn that cousin Martin experienced such glooms. That in itself was evidence of how distant they were, and yet here he was having to do the eulogy at Simon’s mother’s funeral.

‘As soon as we’ve sorted the arrangements, I’ll let you know,’ Simon continued. ‘There is a chance we might be able to get a slot at the crematorium on Tuesday. It’s a bit quick, but the formalities are done and most people who would want to be there know she’s gone.’

‘OK,’ Sturrock said, while secretly cursing to himself. If it was as early as Tuesday, he would have next to no time to rearrange all the appointments he had for that day, let alone deal with the inevitable knock-on consequences.

Though he didn’t feel it this morning, Professor Sturrock was widely viewed as one of the best psychiatrists in the business. For a fair few London GPs, he was first choice for the mental health cases they felt they couldn’t handle by medication alone. They would happily refer their patients to the Prince Regent Hospital off Oxford Street and its renowned psychiatric unit run by Professor Sturrock. He liked NHS work. He tended to get some of the toughest cases, and they always provided inspiration for his research work. But he also liked to provide real, quality care, and this took time. It meant he could see only a fraction of the patients doctors wanted him to see, especially as he insisted on one-hour consultations for his outpatients. This had got him into trouble with management from time to time, concerned as they were with ‘throughputs’ and ‘patient experience’. But given his record and reputation, he was able to operate as something of a law unto himself. ‘Patient experience’ was important to him too, but in a very different way.

Stella’s reaction, as she picked up on his angst about having to mess around his patients, had further worsened his mood as he gathered his papers and packed them into his brown leather briefcase.

‘It’s your aunt we’re talking about, Martin,’ she said as he headed for the front door. ‘A little bit of humanity wouldn’t go amiss.’ He nodded, and left.

On the tube, he’d felt more than usually suffocated and starved of space, but now he was in his consulting room, he could breathe again. It was his sanctuary, the place where, when he was alone, he could think. Through the frosted-glass door he could see the shadow of Phyllis, his secretary-cum-receptionist, getting ready for the day ahead, just as she had done every weekday morning for the twenty-plus years she had worked for him. He buzzed through to her, to warn her she might have to rearrange things for Tuesday.

She was a large, rather stern-looking woman, not terribly prone to laughter, who liked everything to run precisely as planned. It was exactly what bosses look for in a secretary, but at times it irritated him, particularly when she was unsympathetic to patients who missed their appointments. She seemed to have very little understanding of the courage it took for some of his patients to get themselves to the hospital. But he knew he was lucky to have someone who always appeared able to take changed arrangements in her stride. When she’d had three weeks off for an operation, he’d realised just how much he relied on her. The place virtually fell apart. But though he and Phyllis were such an important part of each other’s lives, they were not particularly close. He gave her a small birthday present in March, and a larger Christmas present each year, but they never socialised.

His consulting room was on the sixth floor of the new Le Gassick wing, named after the businessman and philanthropist, Stuart Le Gassick, who helped to fund it. It was built five years ago, just before his father died. He had a nice view over low rooftops to the square nearby with its well-kept private garden in the middle, though an enormous new complex of business premises and luxury flats was in the process of being built in between. He feared that once it was completed, he would lose the little glimpse of grass and bushes he could enjoy when he stood at the far corner of the room. The furnishings were a mix of classic public sector functionality and several items – including his mahogany desk, his swivel desk chair, and the two brown leather armchairs he used for patient consultations – that he had brought with him from his old room in a part of the hospital that had since been converted to a lecture theatre.

He had just ten minutes before he was due to see his first patient of the day, Emily Parks. Just ten minutes to think about the four consultations planned for the morning, and in the afternoon the budget meetings and the appointment with Hafsatu Sesay, a young woman from Sierra Leone who had been the victim of a particularly brutal sex-trafficking scam. She was a patient whom Sturrock found particularly challenging. Ten minutes wasn’t long enough. He cursed last night’s dinner for a visiting American professor, who was over studying some of the work he had done on the use of dreams in the analysis of addiction and depression. The dinner hadn’t finished until 11.20, so it was nearly midnight by the time he got home and he was too tired to do his usual day-before review and planning.

Each of the morning’s patients was challenging in their own very different ways. Emily Parks was a burns victim who had lost half her face in a house fire three years ago and who was so permanently conscious of her disfigurement that she was scared to go out in daylight. At 10.15 he had David Temple, a serious depressive whom he worried might one day cause harm, to himself or others, and then at 11.15, Arta Mehmeti, a refugee from Kosovo who had been raped in her south London home while the rapist’s accomplice held her young daughter hostage in the kitchen. In her dreams, Arta was stalked nightly by the rapist, making a normal sex life with her husband impossible. To wrap up his morning, at 12.15 he was seeing a new private patient who wanted to come and discuss his sex addiction. He was always keen to have private patients. The income helped him fund his various research projects, his current one being a study of the psychiatric impact of resettlement on asylum seekers, particularly from the Balkans and African war zones. But he didn’t like sex-addiction cases. They made him feel uncomfortable.

Sturrock wondered whether David would turn up. He had missed several consultations in the past, unable even to get out of bed. If David didn’t show today that would at least give him time to check his emails and see whether Arta had sent through her ‘homework’. At the end of most appointments he would set his patients some task for the week ahead, and many of them, Arta included, would email it to him the night before they were due to see him. However, he worried that if he was deprived of the chance to talk to David, his mood might sink even further.

Sturrock marked his depressive patients on a scale of one to ten. Most of the people he treated were between five and eight. He had never had a ten. He put David at seven, which was bad. He put himself at six, but didn’t let anyone know, which ran counter to the guidelines for psychiatrists who feel they may have their own psychological issues. He knew the guidelines better than most, having updated them personally four years ago, but he could see no point, for himself or the department, in drawing attention to his own shifting moods. Instead, he tried to manage them himself. And seeing David helped.

Though in times of depression, David had self-esteem perhaps lower than Sturrock had ever witnessed, he had in his lucid moments an ability to articulate his depression that the psychiatrist found moving, humbling. He thought of one of David’s descriptions now as he heard Phyllis greet Emily Parks in the waiting room outside. ‘It’s like a storm coming,’ he’d said about the feeling before a plunge. ‘There’s a moment when the sky darkens, you know what’s coming, and you’re powerless to do anything about it.’