All in the Mind (2 page)

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.’

‘Me?’

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.’

‘Are you sure I’m the right person?’

‘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.

‘Sorry to hear about your aunt,’ she said.

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.’

2

As Professor Sturrock was consulting his schedule, David Temple was already just a short walk away, sitting in a scruffy little café used mainly by builders working on the new shops and flats going up by the hospital. He sat drinking a mug of tea, pleased with himself that he had got this far. He had more than an hour to steel himself to take the final steps to the hospital and up the stairs to the sixth floor of the Le Gassick wing, where the kindly psychiatrist and his rather forbidding receptionist would be waiting. He had been in this position before, come all this way, sat in this same café, with its Formica tables and classroom chairs, and then decided he couldn’t face it, and gone back home. Some days, it was just that he couldn’t summon the will to talk about the way he was feeling. More often, he would ask himself what right he had to take up the time of someone like Professor Sturrock. Even now, looking around the cafe, he saw people who probably had far worse problems than his. Was it a problem demanding of a doctor that he couldn’t get out of bed in the morning? It made him feel small, unworthy of the space he took up.

Yet despite everything these sessions stirred in him, he had come to depend on Professor Sturrock, almost to look forward to the weekly meetings where they went through his dreams and other homework tasks, and he tried to describe the shifts in his mood. They helped. And today he needed help. He was still shaken by his conversation with Amanda at work yesterday. With every conscious effort he made to shake it clear from his memory, its grip on his mind tightened. He watched a waitress wipe away a stain on the table as she brought
him
over another mug of tea. Why couldn’t he wipe his mind clean so easily?

He had got this far, he told himself, so just do what the Professor said – a step at a time; live in the moment; look for the good things not just the bad. It had helped get him out of bed when he woke up with a seven-out-of-ten dead feeling. It had helped him out of the house, onto the tube, including a change of line, off at Marble Arch, then on the little stroll to the café. From where he sat, he could see the window of Professor Sturrock’s room. So he was close. Live in the moment, he whispered to himself, then the next one, then the one after that.

David Temple was thirty-three but looked closer to fifty. He had been bald since his early twenties and his forehead was already quite heavily lined. He had realised, since seeing Professor Sturrock, that he had probably been suffering from depression all his life, but he had only been diagnosed as needing treatment three years ago when he’d tried, with no real risk of success, to kill himself through an overdose of his mother’s sleeping pills. ‘Can’t even kill myself properly,’ he said to the nurse in accident and emergency. It was a year later, when he became a so-called ‘risk to others’ that he was sent to have sessions with Professor Sturrock.

It had happened in a park near his home one evening. He had been feeling very low that day and everything at home was driving him deeper and deeper down. He lived with his mother in a rented two-storey flat in the shadow of Pentonville prison, having found life on his own worse than life with her, even though often she was the thing that sparked what Professor Sturrock called his ‘plunges’. She knew the rhythm of his moods almost as well as he did, having lived with them for so long, but long and painful experience had made her no better at dealing with them. Her answer to everything was either to suggest he go and have a little chat with Father Nicholas, the priest at their local church to whom she turned whenever
she
had a problem, or that he have something ‘nice’ to eat or drink. Each exhortation, each suggestion of a new foodstuff would make him feel he was slipping down another notch. He knew the feeling too well, a gnawing
emptiness
expanding beyond his own body space. The empty feeling would start as a knot, somewhere close to his stomach. It would then grow outwards, sometimes in circles, sometimes in irregular shapes, but before long his entire insides felt as though they contained absolutely nothing. No flesh or blood or bones, no breath, no pain even, no feeling beyond a dull ache that he could only describe as emptiness. How was it possible, he wondered, to feel totally, absolutely empty, and yet to feel even emptier the moment his mother suggested another meal she might serve up to make him ‘feel a bit better’?