The Skeleton Cupboard (10 page)

She had watched her sister fall into the swimming pool at their home and had then gently placed her foot on top of Maisie's head to keep her under the water.

In order to protect her sister from sexual abuse, Imogen had been making herself available to her stepfather; she thought that if she always let him enjoy their “special friendship,” he would never go near Maisie.

But it was getting harder. Imogen realized her stepfather didn't want her anymore, she was growing up, becoming less attractive to him. He wanted only the very young. Imogen knew that she had been passed over for her little sister.

“I didn't mean to let her die. I didn't plan for it to happen, but when she fell into the pool and I couldn't pull her out, I realized what I could do to help her.”

The air smelled of pond water and puke.

“I killed my little sister, Maisie. Please will you tell the police and take me to prison?”

I scooped Imogen into my arms and walked her out of the pond as she laid her exhausted little head into my neck.

As we walked into the unit, the analyst met us at the door and wrapped us both in a large, warm blanket.

 

Three

PRACTICE TALES

Martin was uncomfortable. Red-faced, looking at the floor, he was doing the best hand-wringing that I had ever witnessed, while his partner, Elise, sat bolt upright and struggled to explain their difficulties. I wanted to reassure them, but the air in my new office was crackling with collective embarrassment. Martin and Elise had come to see me for sensate focus sex therapy—a brilliant and effective technique, but a bloody scary one to administer. This would be a long session.

I had been at Market Street GP Practice for only three days. I hadn't figured out how the coffee machine worked, I was still struggling to remember the names of my new colleagues, and I felt completely freaked out by the pile of thick brown patient notes on my desk—referrals all waiting for me.

It had been a few weeks since I had last seen Imogen, but I hadn't shaken her off. She remained with me—I even sometimes dreamed about her. I knew that she was safe, that her stepfather had been charged, her mother was divorcing him and relocating to America so Imogen could be nearer to her own father when the new baby arrived, but I missed that little girl and felt I needed to see her from time to time, to check on how she was doing. Clinical training, with its six-month chunks of placement, felt very brutal, and I vowed not to get too attached to my next batch of patients.

I couldn't believe it had gotten to the point where I felt I needed to be so cut off from my patients that I had started referring to them as a “batch.”

I was glad I was in a GP practice. I think the university had felt sorry for me, finishing such a harrowing child placement without the support of my supervisor, and so they had put me somewhere less challenging. I was grateful.

The practice felt more comfortable and familiar than my previous two placements. This GP clinic was just like any other based in a large city: slightly dingy, too small, always cramped with waiting, coughing patients, crying children banging grubby toys, phones ringing endlessly for appointments to see the six overworked GPs. I felt I could do this.

The only challenge, I thought, was going to be seeing Chris again. She had returned to work, and I was trying to pick up from where we had left off without showing her how abandoned I'd felt. I wanted her to see how strong and capable I'd been. I had helped Imogen on my own, hadn't I? But I still felt like Chris had let me down. Being left without her support in a difficult placement with such an unwell child had made me incredibly anxious. It was as though she had dumped me. I was pissed off that she could make me feel so vulnerable.

At the end of my first week at the practice, I went to meet her in the Market Street café near the surgery. It was a bright autumn morning, and the market stalls were being put up all along the street. The windows of the café were fogged up. When I entered, I saw Chris was already there, sitting at a table near the back. My heart was pounding.

Our greetings felt stilted; she was perfectly polite, even pleasant—she was smiling—but guarded. She bought us coffees and then insisted on buying the next round too.

“You look well, Chris. Really well.”

She looked down into her espresso cup. “Yeah. Thanks. I feel pretty good.”

This was bloody uncomfortable. I didn't know whether to talk about the big elephant sitting on the chair next to us. Chris broke the silence.

“So, I hear you did an amazing job at the end of the adolescent unit placement.”

“Really? Who from?”

“I have my sources.” Chris chuckled.

“No, really, Chris—who'd you hear that from? I mean, I finished the placement on my own.”

Chris frowned. “Well, not on your own exactly…”

“Yeah, actually, I think I did.”

Shit—I was getting angry. I knew I should just move on and get down to the business of this new placement, but I just couldn't help myself—I needed to hear her explanation, an apology, something.

Sipping my second coffee, I burned my mouth.

“So, where did you go exactly?”

“Pardon?”

“You know, during my last placement. Where were you?”

Chris's eyes hardened. “I believe that you were told I was off for personal reasons.”

Blowing into my coffee, I nodded.

“So what else is there for me to tell you?”

My heart lurched. Chris was doing her staring, nonblinking thing. I knew I couldn't face this down.

“No, nothing else. I mean, I just wanted to know that you were OK.”

“Didn't you just tell me I looked really well?”

I nodded, feeling sick. “You do.”

“Well, then there's nothing more to say.” Chris smiled at me, raised her eyebrows and stirred a sachet of brown sugar into her espresso.

I struggled with the uncomfortable silence.

“Right,” she said. “Let's get on, then. So, between a quarter and a third of patients who visit their GP surgery have mental health difficulties. But I expect you already knew that.”

Bloody hell, this woman raced all over the place. Clearly we'd moved on to business. I was still lagging in recriminations. I snapped into trainee mode.

So, between a quarter and a third of patients who visit their GP surgery have mental health difficulties. I didn't know that; blimey, that was a lot.

“Yes, I was aware of that. Hope I am not expected to see them all over the next six months!”

Why was I trying to be funny here? Why did I feel like the naughty kid in the room trying to make Mummy like me again?

Chris continued to sip her espresso. “What do you think about the Goldberg and Huxley model?”

Shit.

“I'm not sure I know that one.”

Give me a break, lady. I'm only a year into clinical training. I've already dealt with a sociopath and a suicidal kid—on my own.

Chris slapped a brown folder on the table; it was filled with academic papers. “You need to read these.”

I saluted. “Yes, boss.”

“OK, well, I'm off. Good luck.”

What?

“Hey, hold on! What's the plan for this placement? Who am I seeing? What are the problems?”

Chris stood up and looked at the brown folder. “You'll find it all in there.” She walked off, and as she reached the café door, she turned. “Shame you didn't think to prepare.”

The bell jingled as the door shut behind her.

Unbelievable. This woman had reappeared in my life after buggering off for “personal reasons”; she refuses to give any kind of explanation, no congratulations for my work with Imogen, manipulates the conversation so that I end up looking like the idiot, and then tells me off—in public.

Thanks a lot, Chris. Bitch.

People in the café were looking at me. An old lady at the next table reached her mittened hand over to me and patted my arm.

“Ooh, dearie. I think you just got a scolding. Never mind.”

She offered me a plate with cake on it.

“Have some Battenberg—that'll cheer you up.”

Fantastic. Placement number three and already screw-up number one.

*   *   *

Sensate focus therapy works from the point of view that sex infused by anxiety requires a systematic desensitization program. It's a stepped, gradual approach to sex that is directed by the therapist and enables couples in a sex rut to retrace their steps, start from the beginning and move forward slowly. The boundaries set by the therapist are deliberately frustrating.

A heterosexual, sexually disengaged couple frantically trying to penetrate when she is tight and dry and he is soft is a recipe for disaster. Martin and Elise were in exactly that position.

The sensate focus program enables a couple to “rediscover” each other sexually. You begin with over-clothes touching and kissing, and you're rigidly forbidden to move on to the next step (over-clothes massage, plus upper-body caressing) without the therapist's permission. The theory is that a couple instinctively want to push against the restraints. But if you hold them back and let them progress to the next stage only with the therapist's permission, they'll soon be on fire again.

In a way, my role was to help Martin and Elise become teenagers trying to get away with what they could do on the sofa at home—to make their sex “naughty” and fun again. I was to be their sex guide, their controlling dominatrix.

All this was beautifully psychologically justified within the evidence-based theory of phobia management. Step by step, I would desensitize them to their anxiety related to sex. But in practice, of course, it was bloody weird to do.

I cleared my throat. “Would anyone like a glass of water?”

They both shook their heads.

I did need a glass, but I felt unable to move, pinned to my seat by two pairs of anxious eyes.

“OK. Let's get going.”

Martin shifted in his seat.

“I am sure this feels a bit odd, you know, talking about your intimate, er, behavior with a total stranger, but”—I gave a strangled laugh—“we'll all muddle through.”

Muddle through?

“So, Elise, just so that I am clear I have understood what you have told me: You and Martin have been together eleven years?”

Elise nodded.

“You are engaged and getting married next summer?”

Another nod from Elise.

“Congratulations!”

A couple of small, coy smiles.

OK, getting somewhere.

“And, well, it seems that you are struggling with sexual intercourse and want some help to get things back on track, as it were.”

Martin closed his eyes and exhaled softly. Elise took his hand and nodded again.

“So tell me a bit about yourselves.”

Elise looked at Martin, who raised his eyebrows.

“If you don't mind, Martin, it would be great to hear from you.”

Martin went white. Elise squeezed his hand.

“I think I'll do the talking for the moment if that's OK. He doesn't want to be here”—she turned to her shiny-faced partner—“do you, darling?”

He shook his head.

I smiled at Martin; he flicked his eyes away.

“Of course.”

“Well, we are both thirty, aren't we, Martin?”

A painful nod.

They've got seven years on me.

“We met at university. We lived in the same halls in the first year.”

“Oh! Which university?”

“Cambridge. I was doing English literature, and Martin—you read history, didn't you?”

They're cleverer than me.

I didn't even wait for any kind of response from Martin.

“Anyway, I now work in publishing, and Martin's a—”

Martin sat up in his chair and made eye contact for the first time. “I'm a political journalist.”

“Well done, darling!”

Elise beamed at her fiancé; he looked puce. I could barely breathe.

“So, how can I help you?”

Martin began to speak, but Elise cut across him.

“We are very happy, aren't we, Martin?”

No response from Martin.

She carried on. “And very excited to be getting married. And very content with our lives.” Elise glanced at me.

I nodded and smiled.

“Sex, however, is a bit of a problem.” She gave a small laugh. “Not a massive problem, but one we'd like to sort out now. I mean, we like to do things well, don't we, darling?”

Martin had his eyes closed. This was hellish and so time for an intervention.

“Maybe it would help,” I suggested, “if I told you what your GP, Dr. Abrahams, has told me in his referral note.” I opened the file. “So, it seems that, Elise, you presented with vaginal dyspareunia—pain during intercourse—which after examination was not found to have any underlying physical cause. And also, Martin, you are struggling with erectile dysfunction and premature ejaculation. So, psychosexual issues that can be dealt with. I am very happy to meet you so we can get going,” I finished with a flourish.

The silence in the room was stony.

*   *   *

“Well, that was a beautiful example of a mistimed intervention.”

I was on the phone with Chris.

“What do you mean?” I asked.

“What I mean is, a therapeutic foot in mouth.”

“Thanks, Chris. I had already worked that out. I need your help here.”

Apart from some chomping, salivary noises, there were no words from the other end of the call. I hate people who eat while on the phone; they make me feel homicidal.

“Listen, Chris, before we carry on talking about this couple, I've got to ask you something. I mean, seriously. Why did you walk out on me in the café?”

More slurping. My stomach muscles clenched.