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Editorial

5th February 2017

It’s tricky to judge when orders are required to achieve the outcome of improved symptoms, better understanding or longevity.  Ordering implies an authoritarian relationship with one party knowing ‘what’s best’ for the other and, more sinisterly, expects obedience of the other.

 

Most doctors nowadays are trained to work collaboratively with their patients, to communicate clearly and empathetically so as to enable people to make informed decisions for which they, not the doctor, are accountable.

 

Using even more sophisticated cognitive psychological techniques, a practitioner may lead their patient to a ‘guided discovery’ of their thoughts or behaviours, often not obvious initially, that are affecting their symptoms or experience.

 

Some of the stories demonstrate how the power of an authoritative trusted position such as that of a doctor can use the relationship with the patient to achieve a personal or political goal.  In contrast, in other stories the ‘order’ was often a simplified representation of the consultation they might have had with a doctor, eg to take a holiday, to drink orange juice, or to get a prescription.  In these stories the ‘order’ came to be both a very literal undertaking for the character, but also a metaphor for the complexity of the change in their health, behaviour or mood they hope to achieve.

 

And yet, ‘doctor’s orders’ prevails.  ‘If it were you doc, what would you do?’, ‘if you think it best, I will take them, you’re the doctor!’  For some the anxiety that comes with facing no simple ‘order’ but a self-made decision can itself require intervention!

In a cynical twist, the character in the winning story longs for his life before following his doctor’s order, a time when he did not take responsibility for his behaviour, his health or his economic contribution, thus expressing how burdensome being a mediocre sentient being can be.  This dark, though comic view, avoids all sentimentality and offers us something closer to the true complexity of human experience, not just polar views of functional and dysfunctional.

Adding the strange phenomena of hypnosis into the relationship between doctor and patient of course makes a mockery of accountable decisions.  The thriller of the revengeful hypnotist is very entertaining.

 

Lastly, the description of a young man’s experience of being given a prescription for an antidepressant evoked in me an empathy for the character, feeling his embarrassment, his paranoia, his vulnerability as he realises that depression could happen to him too.  It felt a very accurate description achieved with simple observation and communicated subtly.

 

I suspect that often my collaboratively communicated advice evolves into a ‘doctor’s order’ when relayed by patients.  As a dermatologist my advice to avoid excessive hand washing to improve hand eczema becomes ‘I am not allowed to do the dishwashing or cleaning’, to people with some inflammatory skin diseases for whom I might recommend sensible ultraviolet light exposure, ‘the doctor said we should have a sunny holiday this year’.

 

Thank you for all your stories.  Keep writing – it’s an order!

Maria

 

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About the Judge

 

Dr Maria Martin is a General Practitioner in the NHS in Cumbria, England where she consults patients and manages a practice with her colleagues.  She runs a community dermatology service as a GP with Extended Role.  Her other clinical interests are sexual health, mental health and cognitive behavioural therapy.


Ephemera

Touching down on the tarmac
she almost wants, still
to kneel, kiss the ground.

It’s a homecoming
although she hasn’t traveled far
she feels blessed to be back.

Her exile is self-imposed
of sorts. She made her bed.
And what a glorious bed it was,

for a while. And now, she lies
in it with her mixed-blood children,
her foreign husband. Sometimes

she dreams the life she might have had
if she’d never left home. Close
your eyes, squint and you might see -

it could have been easier. But then
friends tell her she’s living the good life.
All they see is the holidays they take;

forgetting how even silver tarnishes with use.
She wonders could she come back, out
of exile to this promised land of green

fields, grey stone houses, salt and vinegar
crisps, warm beer? But then
there are all the things she would miss:

bread, wine, cheese, all such clichés
but they have become her currency.
This is not the worst of it. She thinks

of how her children’s voices would sound
strange here. They would be the ones
marked out as different. No. There is

no easy way back from exile in the end.
Too long gone, the land she knew, the land
she might return to, is a foreign one now.



The… Understanding… Heart

Last week's competition

Featured Entry

by odgemob
Here I sprawl
Stare at the plant on the windowsill
Dusty sunlight cupped in its white petals.
In my stomach the morning's excesses of caffeine mix with something else
Something unwanted and shameful and just past understanding
Something like lust
Something like love
For someone who is
Too much of a friend
To be shrunk to a snapshot of desire.
The awful realisation of it curdles with the coffee
Sends tendrils of electricity groaning dangerously to each edge of me.

It turns the feeble flower to an angel's wings.

In her new chair my grandmother slumbers in and out of the day.
Once, with a twinkle in her eye, she talked about heartbreak
Assured me with glee that one day soon I would "fall terribly in love"
But I
(politely laughing and curling my toes)
Hated the word and the way she said it
Hated the time that trapped me in the room with her
Hated the heat and the twirling wreath of memories and her smug prediction of my own future weakness.
I remained quiet and swore that I would stay forever upright.

Now, in this time, I think I would quite like to open my heart to hers
but it is too late
Her mind has eroded
Flashes of rain on an unpaved path
Washed away
Left behind
Scattered
Colours
The beginnings of sentences
and in other places
Nothing.

I would like to hear her stories one more time
To know that what is raging inside me
May be ugly like a lightning-scorched tree stump
And crude like sharp-edged etchings on cave walls
But at least it was felt too by neat, sensible-shoed girls with 1940's hair
Who lived to laugh and to tell the tale.

Her heart is still understanding as it always was
But my words would roll like water from the duck's back of her mind
Before they even reached it
So I simply squeeze her fingers
(whilst inside me that timeless song screams and aches)
And ask her if she would like another sip of soup
"It's cream of asparagus. Quite nice, I think. Just one more sip before it gets cold?"

Last Week's Winner!

Winning entry by Madkins
Does absence make the heart grow fonder?

Time passes with no fleeting remembrance or even a
stare in your direction.
The seconds, minutes, hours, days, months and now years stumble and blend like a montage of
emptiness.
Gone. Can you hear the whisper of goodbyes?

Waves of liquid ice meander through
tunnels that touch and render the epidermis warm.
But the struggle of heat elsewhere falls short,
And in that same failed place, there is a vacancy to abort.

A perplexed iamb, now of steel, strikes at the core not once but twice,
It waits. Lub dub. Isolated.
Except the fractures never heal, not completely.
What’s left is a magnitude of chips, battle scars, lowering their gaze in shame.

Still, life peeps through obscurity;
Steps on each shadow like puddles in December.
The path for that desire is axiomatically unfamiliar each time you try and take it.
But that never stops us.

Who is proud of being alone?
Are you?

Featured Entry

by Tauren
“Empathy is the flail that makes ruin of open hearts” FS.

Patricks hand darted for the phone on the first ring, then paused it over the handset. Calm down, take it easy, he chided himself; his heart was racing, his first solo call. He let it ring two more times before picking it up. His attempt at a casual, “Hello?” was greeted with silence, he waited, then tried again, “Hello?” the line went dead. His shoulders slumped as he replaced the receiver, his first call and he`d blown it, he looked at the clock, just after 11:01 a.m.
He was just starting to give out to himself when the phone rang again, this time he reached out more slowly, “Hello,” he said, “I`m listening?”

No-one answered, was that breathing he could hear? He looked at the clock, watched the second hand tick away fifteen seconds, which felt like an eternity, before he tried again, “Hello, I`m listening?” three more seconds ticked past, the line went dead once more.
Was it kids he wondered, as he replaced the handset, or worse a drunk who thought it would be funny to ring the Samaritans and wind someone up; it was a Freephone number after all. They`d warned him about that during training, how to handle it, he hoped it wasn’t; Emily`d told him some of them could be quite abusive.
The phone rang again, he let it ring four times before answering, “Hello, I`m listening?” he waited for laughter or abuse.

Instead a small quiet voice, it sounded like a young girls said, “Um… I… um,” and lapsed into silence, he thought she sounded scared.

“It`s okay,” he told her, “I`m listening.”

“Um, um, it`s Bethany`s… last year my sister, today, last year she found.. no, my mum`s… my mum`s not well and she can`t sleep and Bethany….last year today, Bethany….” She lapsed back into silence, her breathing, quick and ragged, was louder now.

“It`s called active listening,” Mary their supervisor told them during training, she explained it to them and he said he understood, she told him he didn’t and explained it again and then a third time.
“People don’t listen,” she said, looking directly at him. “People think they do, but they only half do. They listen to what the other person is saying until they think of a rebuttal and then they stop listening, waiting for the other person to stop talking, waiting for their chance to jump in.”
“Active listening means you don’t have an opinion, it`s not a conversation, they talk, you listen. You do not interrupt, you do not offer advice or opinion, you sit and you listen, nothing more;” Patrick thought it sounded more like passive listening, but he never said that.

“I`m listening,” he prompted again, worried that she might have given up.

For a while she said nothing, but he could still hear her breathing, then in a rush she said, “Bethany died a year ago… today; a year ago today. She took too many of mum`s pills, the ones she needs to get too sleep. She told me she would, but I didn’t believe her. She said, she said she couldn’t do it anymore, she said…” abruptly she stopped talking.

“My dad he, my dad he…. My dad…he,” it was as if she couldn’t get past those three words.

“When I was eight, when I was, when I was eight, my dad he, he….” She sobbed, just once, a terrible lonely sound and went quiet. Jesus not that, he thought, not on my first night, not a sex abuse call, instantly hating himself for being so selfish.

“One night, when I was eight,” her voice was trembly and weak, “One night after my eight birthday; after my mum had taken her pills, my dad, he,” there were those three words again, but this time she got past them.

She told him about the first time; it came in fits and starts. She`d get so far, stop, sob a little, go back, tell some more, stop altogether, restart, cry, apologise for crying, apologise for telling him all this, then start again, sometimes from the beginning.
She told him about the first time, five times, every time telling him a little more, filling in more detail. He could feel his grip on the handset tightening all the while, heard the plastic creak in complaint under his grip.

She told him about the second time, about her older sister Bethany lying perfectly still in the next bed her eyes wide watching the whole time. She told him about the time after that and the next time and the next and the next, until they blurred into one wretched event.

She told him what he did to her, the things he used, the bruises and the bleeding, how Bethany would clean her up, wipe her tears away and rock her to sleep after…… and she told him about all the things he made her do to him, things that made Patrick`s skin crawl.

It was when she told him about her lying there, still as could be, watching him doing all the same awful things to Bethany, that he heard how shallow and raspy his own breathing had become and he lifted the mouthpiece away from his lips, afraid she would hear.
He listened and learned to hate a man he`d never met. Listened, alternating between white rage and all-consuming pity. The cubicle and the desk disappearing; his world compressing down to the chair, the phone and her voice, there was nothing beyond that.

Whenever he sensed she might be on the verge of hanging up he`d say, “Go on, I`m listening.” The words sounding more tinny and false with every retelling, like worthless platitudes, and him feeling as useless.

Then in a wretched voice she said, “Audrey was eight last week,” and began to weep, weep like she might never stop, drawing tears from a well far too deep for one so young. He heard the cluck clunk of the receiver being put down. She hadn’t hung up, he could hear her crying and had a vision of a girl, who couldn’t be more than thirteen, standing alone in a phone box in the depths of a miserable winters night, her face in both hands crying her heart out, not for herself, not for her own lost childhood, but for her little sisters.

His throat ached from the effort of holding back his own tears as he heard her weeping turn to sobs, then to gasping, catching, hiccupping breaths, and finally to silence.
He listened, pressing the receiver so hard to his ear the side of his head hurt, despising himself for even noticing.

There was a rattling metallic sound as she picked up the phone again, and when she spoke her voice was hoarse and tired, but chillingly firm, “I can`t do this anymore,” she said, and the line went dead.

Patrick pulled the phone from his ear and looked at it, in a moment of panic he thought it might have stopped working, but when he put the handset to his ear again he heard the dial tone`s soft purr.
Can`t do this anymore, he thought, what this? This what? This phone call, this, this; he didn’t want to think what other this she could have been talking about. He wanted her to call back and then stupidly realised she couldn’t with the phone off the hook and slammed it down on its cradle, his hand hovering over it ready to snatch it up as soon as it rang.

He glanced at the clock 11:32, had it really been thirty minutes? It felt as if less than five had passed since he`d first answered the phone; “Please ring,” he pleaded softly, “Please.”

What this? What this? Those two words battered themselves against the cage of his imagination, giving breath to every possible ending.
He began to second guess himself, was it something he said, something he didn’t say? He ran through what she`d said back and forth, all the time trying to unpick the words, “can`t do this anymore,” from his mind.

At 11:34 the ache in his shoulder became unbearable and he was forced to drop his hand, resting it on the handset, his fingers curling around it, still ready. He dug the fingers of his free hand into the muscle, revelling in the sharp pain.

At 11:35 he started to worry that the phone might be broken, what if he`d damaged it when he slammed it down like that? He should check and see if he had a dial tone. What if she was trying to get through, but couldn’t? But what if he picked it up and she rang in that moment? Indecision paralysed him.

By 11:36 he`d almost convinced himself that she had rung back and had gotten through to one of the other volunteers. Maybe right now she was talking to Emily or Joan. Yeah that’s right; she was talking to one of the women, she hadn’t wanted to talk to him at all; he was a man. Hadn’t she hung up the first two times he`d answered because he was a man, he almost talked himself into believing it…. almost.

At 11:37 he took his hand off the phone, stood up, opened the door of his small windowless cubicle, and stepped out into the hall.
At the end of the short corridor light glowed through an opaque glass door; it took him four steps to reach it, he rapped softly on the door and without waiting for an answer pushed it open.

Mary looked up, saw his face and gestured to a chair, “Sit down,” she said, and though he never heard a word, did so anyway.

He sat, slumped forward, legs splayed, forearms resting on his thighs, hands, palms up, hanging limp. He stared at his hands, they were shaking, why were they shaking so much? He wanted them to stop, ordered them to; stop shaking, he thought, but they ignored him.

What this? What.. this? What….this?

He curled them into fists and they went on shaking, why won`t they stop shaking, he thought, I want them to stop but they won’t, why won’t they stop? It was an effort of will not to pound his knuckles into his forehead; the idea that pain would drive those two words from his mind beginning to become more and more enticing.

“Patrick?”

His head jerked up, he`d never heard his name spoken as gently before. Mary was leaning forward, elbows resting on her desk, fingers interlaced, head tilted ever so slightly to one side as she studied him, real concern in her eyes.

“What this?” he begged in a hollow lost voice, made hoarse from the effort of withholding the tears that were finally coursing down his cheeks; his shaking hands going to his face, to hide his shame, his sense of failure.

She leaned a little closer, and said…… “I`m listening?”
My Notes