Chapter 10 – Pathways

It was that weekend seeing Ben which made me toss the paper I was in the midst of writing, and had dashed off what I was to present a short ten days later.

I stared at the words on the paper just next to my left hand, while my right clutched the electronic dingus which at the touch of a button would display the next slide. The words on the page melded together into a tangled mass, until I took a refreshing sip of air, and began to speak, as my pulse pounded in my ears. "I am Dr. Rachel Timoney and today I will be presenting 'Pathways Through the Jungle – A Patient's-eye View of Coping with Loss.' "

I could see my audience nodding politely in the darkened room. Mine was the last paper of the afternoon, and they must be restive, if not asleep.

A few of them I knew as classmates and fellow practitioners, with a sprinkling of well-known names thrown in. I'd gotten a sneak peek of the attendees of this afternoon's conference, and I was impressed to see some of the better known psychiatric consultants had come. Dr. John Bates from the Crawley Clinic was a giant in dealing with PTSD cases, Dr. Hardcastle of the RAF had done a major paper on military pilots coping with stress, and a host of others, along with Thomas Barnaby, Richard DeVere, and a person I had heard of but had never met – Dr. Ruth Ellingham.

My knees were shaking as I gave my preamble. "We all have patients in need of care; care which if withheld or lacking, may lead to less than successful outcomes, or to outright harm. We review the patient medical and psychiatric history, ask pointed questions, and attempt to define what the person sitting in front of our desk is all about."

I had to lick dry lips. "But, and this is a rather large preposition, adverb, conjunction, or noun, depending on the usage… but, despite medical degrees, years of training, of plenty of experience…"

I watched as the audience developed odd expressions as I got started. Hang on to your hats, people. I took a deep breath, and continued. "Have we ever been there? In that patient's shoes, as it were?" I watched the facial expressions change to internal reflection. Good. Good, Rachel. You've set the hook. Now to bring in the line, slowly.

"Some of you have been – or are – in that place; the bull's-eye in that awful conjunction of fluke, luck, accident, or evil intent; or all four."

An older woman tipped head thoughtfully to one side, closed her eyes for a moment, and then nodded right at me, as if to say 'Go on, my dear. You have my attention.'

I forced a smile and cast it around the room; at the thirty men and women sitting in this stuffy room. "And you know just what I am speaking about." I smiled again. "All too well. And for those of you who never lost their treasured teddy bear on the train…" this brought a moment of laughter from them, "then you have lead a very fortunate and charmed life."

The gray-haired older woman was dressed in a rather old-fashioned blouse, jacket, and plain skirt. She smiled and rolled her eyes in amusement. But as she looked at me I realized who it was. Ellingham – The Ellingham. My God. It must be her. Her papers on the maniac murderers in Broadmoor Prison were nearly legend. She must be nearly eighty, but still practicing, last I heard.

My knees shook all the more. "So imagine, if you need to, that you are that anxious uni student, upset bank manager, or distressed home maker. It's all gone wrong." I pressed the button and my second slide appeared on the screen behind me. It showed six words arranged in a circle around a genderless head and shoulder figure. From the top and clockwise, the words were Grief, Self-pity, Resentment, Doubt, Anxiety, and Distress. I had fashioned lightning bolts from the words toward the center figure, which was labeled 'YOU.'

"I won't try to fashion a snappy-sounding acronym for this. I'll leave that up to Nasa or the Esa." I turned halfway to the screen and, using the laser pointer on the dingus in my hand, projected an arrow pointing at the figure. "That's you, right here in the middle of the mess. It doesn't matter what the individual words are, or for that matter, what caused these feelings to fall on you like a ton of bricks. Your grandfather died? Lost your job? Boyfriend dumped you? A horrible medical diagnosis?" That hurt but it was true.

I saw one or two out there wipe their eyes. Yes, we've all been there.

"Doesn't matter what happened – not at all. And in some cases, the hurt done to you may not even have happened, yet, for you may be imagining possible outcomes…" I shook my head and turned back to my notes.

I went to the next slide and said, "Our job as psychiatric doctors is to help the patient deal not with the feelings – but the facts. Grandfather has died. The job is gone. Boyfriend won't take your call. Or laying in a medical bed and getting grim news." I felt my voice shake, but I continued. "Facts. Facts - those thorny little devils, like your car failing the MOT test."

I saw Ruth Ellingham lean forward with her hand on her chin. Good. I have your attention.

"Yes, here you are. In the desert, lost in the jungle, adrift at sea." Okay Rachel, no more metaphors. I skipped to the next paragraph.

"I have found that exploring the problem from the patient's perspective is an excellent way to travel that gravel road with the patient. Start by helping you – the patient – understand the process, and the path you will follow with the psychiatrist…" I flipped the switch and the next slide was displayed. "This chart shows my data from a series of patient outcomes with and without a clear understanding of what my patient understood of the counseling and treatment process."

From this point my listeners followed every word, and if I had not imparted any major increase on the state of psychiatry, at least I felt that I had unburdened my soul to them, at least in an oblique way.

When finished I got a nice round of applause, and I was only too glad to answer a few polite questions, and then I left the stage. At the seminar reception, I was drinking an orange squash (still no alcohol), making polite conversation with my fellows. I felt both wrung out, but also lighter somehow.

I heard a gentle cough by my side, so I turned, and the gray-haired woman was standing by me. "Ruth Ellingham," she said. "I don't believe we're met."

I took the offered hand and shook it. "No. Rachel Timoney."

"I remember," she chuckled. "Nice work."

"Thank you. I… I'm quite honored to meet you."

"Oh pish, Dr. Timoney."

"No, I mean it. I've read quite a few of your papers."

She sighed. "Dreary reading, I must say. But I quite enjoyed your talk back there."

"Thank you again."

Dr. Ellingham looked closely at me for a moment and her lips twitched. "Walk a mile in their shoes, you said and in so many words."

"Suppose I did."

"Having been in those shoes?" She lifted a glass to her lips and drank. "This is a very fine red wine. And you have given me something to think about."

I tipped my head. "Yes."

"Yes to the shoes, or yes to the wine?" She inspected the glass I was holding where the squash was clearly visible. "Not the wine; the shoes then." She sighed. "Yet you are… shall we say… functional? No more than that, I think." Her thin lips pursed for a moment again. "I wish you well Dr. Timoney."

"Thank you, Dr. Ellingham."

She reached into her handbag and drew out a card which she gave to me. "My contact information. Mobile works best; not so keen on email. Call me and we'll have lunch."

"I… I don't know what to say."

"Say yes. Call me next week. Goodbye." Then she turned and walked away.