The Skeleton Cupboard (3 page)

She's a riddle,

She's a child

She's a headache!

Between bouts of singing, Edith told scrambled stories. “Stinging” was a key word. “Stinging” and “down there.” The “downstairs department.” Aunt Charisma and scrub, scrub, scrubbing. No dreaming. Bad dreaming. No singing. Bad singing. Only scrub and sting and Lysol.

“You lie, you Lysol. You lie, you Lysol,” Edith kept repeating.

In my mind, I tried to sing ahead, to remember the words, as Edith kept repeating the lyrics, her needle stuck in the groove:

She is wild–

She's a riddle,

She's a child

She's a headache!

She is wild–

She's a riddle,

She's a child

She's a headache!

She is wild–

She's a riddle,

She's a child

She's a headache!

I got it and belted out:

She's an angel!

She's a girl …

Then there was a complete stop. Not a pause but a stop. Silence. No song. No moans. No lies or Lysol.

The small woman stood with dignity and straightened the pillowcase on her head. She looked me directly in the eyes, and despite the streams of tears still coursing down her cheeks, she extended a hand. “A pleasure speaking with you.”

“And a pleasure meeting you, Edith.”

“Please call me Maria.”

And Maria walked out of the cupboard and across to the other side of the lift shaft, where the inpatient psychiatric department welcomed her with its familiar revolving door.

Seeing her go, I felt really sad. I thought about some of the recent lectures exploring diagnosis and ethnicity we'd heard at school. It had shocked me to learn that there were disproportionately high levels of psychiatric diagnosis and hospital admissions among black and ethnic minorities living in the UK. African or Caribbean immigrants were up to five times more likely to be diagnosed with schizophrenia, due to the cultural insensitivity that was ingrained in our diagnostic procedures. Poverty, racism and culturally rigid definitions of mental illness all contributed to these troubling statistics and I wondered whether Edith was herself a victim. After many years cycling through the revolving door, had her diagnosed illness become a self-fulfilled prophecy?

“As I say,” said George, breaking the moment, “welcome to our happy home.”

*   *   *

Alone in my cupboard once more, I shut the door and applied myself to getting the space to look more like a consulting room. As it was, I worried it might be slightly insulting for anyone who came in to see me.

“Welcome to the outpatient psychiatric department. We have designed your treatment environment to match the way you feel about yourself,” the office seemed to be saying.

I tidied up: old prescription pads, patient leaflets about fifteen years out-of-date, a guide to electroconvulsive therapy. The thought sent shivers down my spine. I opened a small cupboard next to my desk and shoved the whole lot in.

The chairs needed replacing, so I wandered across the department to see what I could find. In an empty lecture room, I discovered a couple of low chairs. They would do nicely: no disparity in height between my patient and me. I dragged them back past the reception desk without anyone looking up or asking me what I was doing; I probably could have stripped the place entirely and taken it home piece by piece, and no one would have noticed.

Chairs in, positioned at forty-five degrees, it looked better. A few damp hand towels removed some of the visible dust, and then I was on the hunt for a potted plant, which proved more tricky. While considering whether to steal one from a doctor's office more plush than my own, I eventually came upon a bunch of plastic flowers in a small vase in the ladies' toilet. After a rinse and buff with yet another hand towel, they looked rather sweet. I got a coffee table too, and then stood in the middle of my office, pleased with my work.

Nothing to do now but wait for my first patient.

After three years pursuing my undergraduate psychology degree, fierce competition to get into a clinical training course, all the stress of moving back to London, renting a flat in the north of the city and getting myself set up, this was the moment I'd been waiting for. But now that I was here, I felt like running away.

The placement at the hospital was two and a half days a week, with the rest of the week and the odd evening lecture at the university. Effectively, I was seeing patients without any real knowledge of what I was seeing them about: My lectures and the learning I'd need to treat those patients were happening concurrently. Is this what medical doctors in training also went through? Imagine being operated on by someone who has never before put a scalpel into living human flesh.

George brought in another brew, orange, strong and sweet—perfect. He also dumped a pile of notes on my desk.

“Here you go—your first sets of patient notes. Have a read-through.”

I sat there looking at the notes; now everything began to feel real.

There had been a long debate among my clinical year group about whether “they” should be called “patients.” The psychodynamic lot was against it, believing the term demeans the individual, reduces them to a medical stereotype, colludes with the limited but prevailing medical model of mental health. They believed it was better to use the term “clients.” The behaviorists were very much for it: They held that the patients are here for us to treat; they require our intervention; they need the clarity of the well-defined parameters of the relationship between them and us. The psychoanalysts, as usual, were nowhere and everywhere: Why did we want to call them “patients”? What did it defend us against in terms of our own unowned pathology? And equally, what projection did the label “patient” represent in terms of our
overidentified
pathology?

Oh bloody hell, I had always thought. They are so not my clients—I'm not a solicitor or a prostitute. They are patients and may Sigmund strike me down with the full weight of my unowned fucked-upness. They are
patients
!

However, as I edged myself into training and grew more accustomed to my little cupboard in the outpatient clinic, over the next few weeks, I soon realized that they were neither patients nor clients; they were people, real people, with lives and stories—vulnerable, sometimes deeply unhappy, interesting people.

My first few clinical sessions had been alongside qualified staff running anxiety-management groups, which helped me deal with my own anxiety as much as anything else. I then started working with an emetophobic woman who was trying to get pregnant and was terrified of the prospect of vomiting with morning sickness; a young man who was struggling with depression after a serious accident; a woman who had begun to have panic attacks on the Tube and in confined spaces; and an elderly man recently bereaved after many years being his wife's sole caregiver. I loved it. I was meeting real people, each with their own challenging story, who trusted me. I felt I was helping.

*   *   *

A couple of months passed. I discharged my claustrophobic lady, who was now back riding on the Tube. One morning I was sitting in my cupboard, flicking through the notes for a man I was about to see for the first time. It seemed straightforward enough: anxiety and panic attacks. We had had quite a few lectures about those, so I didn't feel as though I was going in totally blind. But a few lectures, some rather self-conscious role plays with my cotrainees and my one discharged patient still didn't allow me to feel quite adequate somehow. What if I made a mistake, made him worse? What if I had a panic attack myself?

A knock at my door and there he was: Ray Robards.

“Good afternoon, Mr. Robards.”

“I'm Ray.”

We sat opposite each other in the low chairs. We shook hands and then settled into a good mirror position; I felt pleased.

“Here's the thing,” said Ray. “I'm a bit freaked seeing you—a head doctor and all. Like, I'm not a nutter, OK. That's the first thing we need to get clear, OK. I'm not a mental case.”

“Why would I think you were?”

“In the waiting room, not only was I sitting among a bunch of tranny freaks in wigs, but I also saw some black bird singing something from
The
bloody
Sound of Music
. She's fucking insane. I'm not. Let's get that clear.”

“I make no judgment, Ray.”

“That's not what I'm looking for.”

“Mr. Robards—Ray. Sorry, Ray. I am clear that you are not insane.”

One–nil to the patient
.

“OK, if you're crystal on that, then we're fine. So what do you want me to tell you?”

“What do you want to tell me, Ray?”

He looked blank.

OK. This is going nowhere. Too much to and fro—get a clinical grip. Get going.

“Well, Ray, why don't we start from the beginning? Why don't I tell you what I know and we can take it from there?”

“Sounds good to me. By the way, did anyone ever tell you you've got beautiful blue eyes?”

Two–nil to the patient. Don't blush. Shit, too late. Focus. Carry on. Maintain eye contact
.

As I felt the familiar feeling of heat and color spread upward from my neck, I turned away to pick up Ray's patient file from my desk. I turned back. Ray was leaning back in his chair, arms spread behind his head, smiling at me.

“You had a series of unexplained dizzy spells at work. Quite worrying by the sounds of it. Can we start from there?”

“Whatever you say, Doc.”

Ray sat forward, his gaze never once leaving me. “I used to collect rubbish. I worked the trucks and emptied bins. That's what I did—did it for years with the same team.”

I smiled and nodded. Ray wasn't smiling anymore.

“Due to circumstances outside my control, however, I had to change jobs. I was gutted. But a man's gotta work and so I started doing security, working the doors, that kinda stuff.”

“You're a bouncer?”

“Spot on, Doc. Clever girl.”

“Do you miss doing the dustbins?”

“Doing the dustbins?” Ray laughed, mimicking my accent as if I were the Queen. “Yeah, but as I say, circumstances outside my control.”

I was curious, but something stopped me from asking for further information.

“Anyway, Doc, it was”—Ray was counting on his fingers—“about eight months ago, when I first got pains in my chest. Freaked the fuck outta me—excuse my French.”

“So you thought you were having a heart attack?”

“No, love, I thought I was coming.”

Where were we now? Four–nil to the patient?

“Of course—sorry.”

“Apology accepted, my beautiful blue-eyed girl.”

This time I had no excuse to turn away and so I decided to front it out. I felt uncomfortable—this wasn't going well.

“To cut to the chase, my old man dropped dead of a heart attack when he was fifty-seven. He did the bins like me. He was an arsehole but didn't deserve to die at fifty-seven. He smoked, drank, the usual, but nothing more than the next bloke. Apparently he had a faulty valve or something.”

“So this is when you went to see the cardiologist?”

“Right. They wired me up, got me running on one of them treadmill things. I had a what-d'you-call-them?”

“ECG?”

“ECG and every bloody test, but apparently”—Ray thumped his chest hard with his fist—“strong as a bloody ox.”

“That must have reassured you.”

“No, sweetheart, it didn't. Not at all. 'Cos I kept having these bloody attacks, as I call them, and they were coming more often and lasting longer, and like a bloody nancy boy I started fucking fainting. On the job.”

“How did the frequency of the attacks change?”

“In English, please.”

“Sorry. How many more were you experiencing? Did they become daily?”

“Yeah, but I could cope with those. The boys would see them coming and take me off the door until they passed. Problem was, also I'd get them sometimes in my sleep.”

“That must have been really frightening.”

“Bloody terrifying.” Ray rubbed his face with his hands. The mask was slipping, the bravado disappearing. “I can only explain it like you're drowning. You wake up and you can't breathe—like you are trying to get to the surface but know your chest will explode before you do. I'd get to the window and open it and try to breathe, but nothing would go in—it was like my lungs had just packed up.”

Ray stopped abruptly. Beads of sweat appeared on his forehead. I could see his breaths becoming faster and shallower. His large hands gripped the arms of the chair. He was beginning to panic.

Thank God for my few weeks sitting in on the anxiety-management group. I began to feel in control. Perversely, that felt good, despite the obvious discomfort of the man sitting opposite me.

“Ray, I want you to breathe slowly.”

“I fucking can't breathe.”

Ray was rasping, his pupils dilating. I leaned forward and took his hands in mine.

“Ray, look at me. Look at me. OK, now listen to me. I am going to count and you are going to count with me. OK? Here we go. One … two … Count with me, Ray. Three … four … That's it. Good. Five … six. Slow it down.”

Ray was squeezing so hard I thought he was going to break my fingers.

“OK, Ray, now I'm holding a candle in front of you and I want you to blow it out in three breaths. Good. Now a little farther away—stronger breaths. Good. OK, Ray, keep blowing as I pull the candle closer to me. That's it.”

A few minutes later Ray was sitting more calmly in his chair, drinking a cup of water. I sat back and felt good—really good. I'd brought his panic down.