Being a wild card isn’t always easy. You are occasionally mistaken for someone else (are you a social worker?) or for someone with more knowledge (are you the lecturer?) and very often, people think you have far, far more experience than you actually possess (I want Dr Cannon to take my blood – no, no you really don’t).
Wild cards carry with them uncertainty, doubt, ambiguity. Why are you here now? Where were you before? Why didn’t you arrive at this point sooner? A wild card feels a constant need to explain and justify themselves, and there is a certain comedy value in being the junior doctor on a team where everyone else is a very great deal younger than you are. Sometimes, though, what you did before, and the fact that you didn’t arrive at this point sooner can, strangely, be played to your advantage.
In my first rotation in psychiatry, in my newly qualified role, I sat in morning ward round waiting to discuss the previous day’s events. I had already spent four months there, and I was the most comfortable I had ever been in my life. Psychiatry was why I had applied to study medicine in the first place. It was all I had ever wanted to do. The thought of sitting in that seat had got me through five years of medical school and the challenges of my previous rotations in medicine and surgery. The team was amazing, the patients were brilliant, and I was welcomed into what immediately felt like a family. Other wards can sometimes seem fragmented and there is a strange disconnection between different departments, but in psychiatry, we were a team and everyone was encouraged to use their individual skills and strengths.
There were people from many different backgrounds: those who had worked in psychiatry for decades, and those who had been drawn to it recently, often due to personal experience or the experience of friends and family around them; those who had moved from completely different jobs, and those who had always wanted to work in mental health. Each of us was listened to, every opinion was valuable, and it was the first time I was asked what I actually thought about something. It was such a tight jigsaw of people that it felt at times as if we had all been conjured there by fate and good fortune, and it seemed to me as though everything I had done before – all the pints I’d pulled and the letters I’d typed, all the innocent bystanders I’d chased around department stores – had given me communication skills and an understanding of people you could never teach to someone in a lecture theatre. Everything had happened for a reason, after all. I could finally put the life I’d had to good use.
I was fortunate enough to do two back-to-back rotations in the same job, but that morning happened to be changeover day for everyone else, and a new doctor walked into the handover. I peered at him over my coffee as he was introduced to us.
‘This is Dr Smith,’ said the consultant. ‘Dr Smith is a Foundation Year 2 doctor. He has more experience than Dr Jo.’
I tapped my finger on the arm of my chair and a bristle of irritation wandered around the back of my neck. Dr Smith smiled at the room. He even did a small bow. He was a good ten years younger than me. He wore a crisp white shirt and a tightly knotted tie, and around his neck was an expensive and very shiny new stethoscope. I thought of the patients next door. I wondered how this was going to work out.
In our first lecture on the first day of medical school, as we were welcomed into our medical career, we were also told something else – something I would perhaps argue about now, but something which broadly makes sense. We were told that there are two kinds of doctor: white coats and cardigans. Those who love the science and those who love the people. Those who order tests for the patients and those who talk to them. Using those (debatable) parameters, I was so much of a cardigan, I was off the scale. Dr Smith, however, was born and bred in a white coat. He had travelled from A-levels to medical school and into being a doctor without taking a breath. I was the wild card. I had taken so many breaths, I was surprised there were any left to go round. Still, the consultant was right. It was true, Dr Smith was more experienced. He was a Foundation Year 2 doctor. He was a year ahead of me on this journey, after all.
We muddled along. If there were new people to clerk, I would take the histories and Dr Smith would take the bloods and the ECGs. In the afternoons I sat in the day room, chatting to the patients, while Dr Smith sat in the doctor’s office, working on his audit. Occasionally, he would appear and hesitate for a while at the edge of the room.
‘Why don’t you join in?’ I’d say, later.
‘I don’t know what to say to them.’
‘Them?’
‘The patients.’
‘Just have a regular conversation.’
He frowned.
‘Talk about the same things you’d talk about to anyone else,’ I said.
He still frowned.
The patients were a mystery to him. The only problem was that the patients soon cottoned on to this. They invented physical ailments for him to investigate, only to give him a psychiatric history when he tried to examine them. They made fun of his stethoscope. They regularly coaxed out his awkwardness and used it for entertainment. I became tired of rescuing him, partly because he constantly built his own gallows but also because there was a strange sense of satisfaction in watching someone else play the wild card for a change. Shamefully, the more Dr Smith floundered, the more secure I felt in my own foundations. Besides, he should be able to rescue himself quite easily. He was, after all, I told myself, far more experienced than I was.
A few weeks after Dr Smith’s arrival, we were both assigned to a new patient as a case study.
She was a young woman, with no history of mental health problems and no prior engagement with mental health services. She had previously been very quiet and reserved. A hard worker. Few friends. Living an unremarkable and un-extraordinary life. However, during the course of one chaotic weekend, and completely out of character, she had stolen a car and driven many miles (without a driving licence) to an unconnected town in the north of England, where she began screaming and shouting at people walking around the shopping centre and threatening violence to anyone who approached her. She was brought in by the police. She refused to speak to any of us.
Dr Smith and I were quite puzzled. I tried to talk to her, but each time I did, she would just walk in the opposite direction. Dr Smith didn’t even make an attempt. She didn’t speak to any of the staff, or to any other patients, and for the most part she would sit in her room staring silently into the walls. Her parents said that, in retrospect, she had become more withdrawn in recent weeks but that there had been no trigger, no inciting incident. There was no trail of breadcrumbs for us to follow.
Her parents visited each day and we relied on them to piece together a narrative. She refused to speak to them, sometimes sitting at a different table, at other times staring beyond them and into the gardens. Still they came. They brought gifts and food and trinkets from home to make her feel more comfortable.
‘Your parents are so lovely,’ I said to her one day, as Dr Smith and I walked back to the ward with her after visiting hours.
I didn’t expect a reply, but she turned to me. Since her arrival, it was the first time she had even acknowledged that anyone had spoken to her.
‘My parents aren’t really like that,’ she said very firmly.
I glanced at Dr Smith.
‘Yes, but don’t you think it’s a strange thing to say?’
Dr Smith and I were sitting in the office a few minutes later.
‘Not really,’ he said.
‘My parents aren’t really like that,’ I repeated. ‘It’s just an odd way of describing it.’
‘She probably meant they’re putting an act on because we’re there.’
‘But that’s not how it sounded,’ I said.
The next day, I marched into ward round. I’d spent the previous evening wading through textbooks looking for answers, and I believed I had found one. I was explaining myself even before I’d taken off my coat.
‘I know what’s wrong with her,’ I said, struggling with a sleeve. ‘I’ve worked it out!’
My consultant raised an eyebrow. Even Dr Smith raised an eyebrow.
I explained the conversation we’d had the previous day, the way she’d talked about her parents. The strange words she’d used. ‘I think she has Capgras Syndrome!’ I said.
My words of triumph disappeared into a silent room.
Capgras Syndrome is a delusion whereby a person thinks that someone close to them – their spouse, their parent, their child – has been replaced by someone else. Someone who looks and sounds exactly like that person, but who is, in fact, an interloper, an imposter.
Capgras Syndrome is very rare.
‘I never thought I’d say this to anyone, but I think you’ve been reading too many textbooks,’ said my consultant, and I could see Dr Smith smirk ever so slightly, ‘but I’ll talk to her.’
He talked to her and it turned out that she did believe her parents weren’t really her parents. She thought they were actors, manipulators, fraudsters. She knew for a fact that these people weren’t really who they were pretending to be, and – of course – the next step from realising they were impersonators was to destroy them. She was quite willing to discuss this, quite happy to talk to us, it was just that we hadn’t asked her the right questions before now, and as luck would have it, I happened to hit upon the right question in that corridor.
‘And you knew all this from that one sentence?’ said Dr Smith later, when we were writing up the notes.
Perhaps it was luck or just good fortune that I happened to pick up on what the patient was really thinking, but I like to think that the more you listen, the more you hear. If you hear enough stories you will come to know where a beat is missing, where a pause takes the place of a word. You don’t have to be a doctor to hear those stories. You’ll stumble across them as you’re pulling a pint or waiting a table. You’ll find them in conversations in a department store and in the queue in a supermarket. The more stories you hear, the more you realise that people always choose their words with care, and words are chosen for a reason. It is, perhaps, something that you learn only with experience.
At the end of the rotation, Dr Smith and I went our separate ways. I went on to another job in psychiatry and Dr Smith disappeared beyond the horizon. If you are worried about him, please don’t be: he found his niche, as I had found mine. A year or so later, we crossed paths again in A&E. He was still wearing his crisp white shirt and his tightly knotted tie, and around his neck the stethoscope still looked new and shiny. He was working with the orthopaedic team. He smiled at me as we passed each other.
Dr Smith was no longer a wild card. He looked the most comfortable he had ever been in his life.