Some musings

THE LIFE I LEAD

Some while ago I was fortunate enough to be sat in Exeter’s Northcott Theatre to see the opening night of ‘The Life I Lead’. It is a brilliantly written play by James Kettle performed single handedly with equal brilliance by Miles Jupp. Through a conversation with the audience, it tells the story of the life of the British character actor David Tomlinson best known for his portrayal of Mr Banks, the father in the Walt Disney film version of ‘Mary Poppins’. It is a warm and gentle two hours which manages to be seriously funny as well as poignant and moving. It leaves those watching with a genuine affection for a man who few will have previously known much about. I’ll not spoil it for those who may yet go and see it but, suffice to say, the play reveals that behind the genial public image, Tomlinson’s personal life, though generally happy was not without tragedy – he was a man who had to live with sadness.

Tomlinson is not alone in having to bear the inevitable sorrows that come as the years pass. Whilst continuing to live and work, attending to the everyday and endeavouring to find happiness, meaning and satisfaction, we all, to a greater or lesser extent, have to endure grief. In that respect, the performance was made more poignant still from knowing that, as he portrayed Tomlinson so perfectly, Miles Jupp was himself carrying a grief of his own, having lost to cancer, less than a week previously, his friend and colleague, comedian Jeremy Hardy. I hope Jupp was able to enjoy performing despite the sadness he was no doubt still feeling – and appreciated the very warm reception that resulted. If he did, then he was not so different from me who was also able to thoroughly enjoy the show, laughing frequently, despite my own ongoing sadness regarding the sudden death of a friend of mine, in particularly tragic circumstances, just four weeks previously.

The evening left me reflecting once more how few lives are devoid of tragedy, but that life is a mixture of the good and the bad and that even when sadnesses come thick and fast, happiness can still be a close companion, intermingling with the sorrow. Life can and does go on, a complex mix of fortune and disaster. Such was the life that Tomlinson led, such is the life I lead and such too are the lives my patients lead.

T. S. Eliot was right when he wrote: ‘People change and smile: but the agony abides’. I see it all the time in my work when a little scratching of the surface all too readily uncovers, beneath the cheery facade, a back story to my patients that I may never have otherwise known about and without which I cannot begin to fully understand their presentation. Why did that woman burst into tears quite so readily over a relatively modest degree of back pain when she consulted this morning? What hidden pain was behind her presentation? What sorrow was she bearing, possibly alone? It’s sure to have been there because ‘everybody hurts’.

I met Jeremy Hardy once. He was performing his stand up show in Taunton many years ago and I went to see him one evening with a friend who was on call for a local GP practice. Those were the days when one could risk, if covering a small practice population as was he, combining an evenings on call with a trip to the theatre provided one was careful to position oneself in close enough proximity to an exit. Predictably enough, my friends mobile went off and as he sloped out to attend to the sick, Jeremy Hardy took the opportunity to extend his routine by ten minutes with a good humoured berating of anyone who would allow their phone to ring in such a setting. My friend made it back in good time though and, having enjoyed the rest of the performance, we were able to indulge in a post show drink in the bar together. Jeremy Hardy was there too, amiably chatting with anyone who cared to spend the time with him. My friend’s phone went off once more and, realising he was a doctor, Jeremy Hardy had a brief chat with us, apologising for his on stage criticism and wishing us well. He seemed to be a genuinely warm and friendly person and I am sorry that he will no longer be entertaining us with his fine sense of humour coupled with the earnestness of his politics. His life too, of course, also knew what it was to experience tears amid the laughter.

Sadness then, is universal, even in the happiest of lives. The causes are many, but can perhaps be divided into the grief felt for the thing which is lost – the regret of the broken relationship, the missed opportunity, the faded dream – and the sorrow resulting from the fear that the future will bring no relief – the loss of hope itself. Sometimes the sadness is easier to feel than the joy.

For some time now, I have been involved with somebody I love who has been experiencing a period of prolonged personal sadness. It is a sadness that makes me sad too. Many will be familiar with the words of the psalmist who wrote, ‘Weeping may tarry for the night but joy comes in the morning’. I don’t doubt the truth of these words but the night for some has already been very long and the day seemingly remains an eternity away. Elsewhere in those ancient writings are chronicled the trials of Job and the ineffectual efforts of his comforters who needed to learn what we too must appreciate – that sometimes it is best to simply ‘weep with those who weep’ rather than to try to argue them out of their sadness or, worse still, point out to the one who is sad the mistakes we think they have made to bring about their misery. Regardless of whether we believe in God, we can I think agree that there is wisdom here.

Regret and sadness have much in common. In my first year as a GP Principal I recall one Sunday morning visiting a patient who had had a few days of severe diarrhoea and vomiting. He appeared sufficiently dehydrated to require admission and I requested an ambulance to attend, not immediately, as I was soon to regret, but within the hour. There was, uncharacteristically for those days, some delay in the ambulance attending, and sadly the patient suffered a cardiac arrest and died on route to hospital.

The next day I chatted to my partners about the case. All were supportive and quick to point out that I had acted appropriately, that if anyone was at fault, it was the ambulance service and that the outcome would likely not have been any different even if the ambulance had attended earlier. But the response that helped me most was that of my senior partner who simply acknowledged that it was tough when things went wrong and related an incident when he had regretted a judgement he’d made some years previously. That such an experienced and respected GP could ‘regret with those who regret” was very comforting for me.

We are all flawed – inevitably even the best doctors make mistakes – mistakes which we may regret for years but from which, having honestly acknowledged them to both ourselves and those affected by them, we can, none the less, learn much. Perhaps it is even true to say that mistakes are in fact necessary if we are to become the more experienced and better doctors we desire to be.

Experience comes over time so older doctors perhaps feel this most. Perhaps they are more accepting of their mistakes and are more used to knowing at first hand what it is to experience the associated regret. Just as Abraham Lincoln suggested that the old have come to ever expect sadness, so older doctors have perhaps come ever to expect regret.

And if mistakes and regret are an inevitable but necessary part of being a doctor then perhaps sadness is an equally inevitable and necessary part of being human. Though for the most part I am happy, sadness sits constantly beside me. That is the life I lead. And If mistakes and regret have the capacity to make us better doctors then maybe sadness has the capacity to make us better people. Perhaps wisdom is acknowledging this. Rather than trying to constantly avoid sadness and, when it does make it’s inevitably unwelcome appearance, attempting to rationalise it away, perhaps we would do well to learn to accept that life is often sad and our lives can, paradoxically perhaps, be enriched by those times

If so, I hope I can become that wise.

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