The Prison Doctor

My hair, short as it was, had managed to find entirely absurd, startled shapes. I flattened it down the best I could with my hand, and swept my fringe from my eyes.

I looked utterly exhausted but I knew I wouldn’t be able to get back to sleep until I had got everything off my chest.

I made my way to the study.

I didn’t need to switch the light on, the moon was beaming through the large sash windows, illuminating the cluttered room.

The shelves were so packed with medical journals they were warping under the weight, sinking in the middle like a hammock. The desk which overlooked the garden wasn’t much better. Either side of the computer were mountains of paperwork. The weight of a life, mountains and mountains of paper, and I was throwing it all away.

Beside the keyboard were silver-framed pictures of my boys in their school uniforms. They sported proud grins. Were they proud of me?

Twenty years. Twenty years of looking after people and it was all over.

I switched on the computer and reached down to turn on the electric heater by my feet. It rattled and hummed, the noise strangely comforting.

I started writing. Pouring my heart out at half past three in the morning, tipping all of my emotions onto the blank page.

It was everything I wished I had expressed in the meeting earlier, every argument against the new contract and their new policies. Explaining exactly how it had forced me into quitting the job I loved.

I wrote for nearly an hour and then sunk back into the padded leather swivel chair, letting out a huge sigh of relief.

What I should have done was pressed ‘Save’, slipped back under my duvet and snuggled into David, now that I had got everything off my chest.

Instead, I pressed ‘Send’.

Chapter Two

I didn’t expect to make the front page!

Sitting in my room at the surgery, I found myself staring at my own words, splashed across the pages of Pulse, a national magazine for GPs.

‘I just ride off into the sunset and no one gives a toss.’

That was what I’d said, but I didn’t think they were going to quote me word for word!

I cursed myself for being so impulsive and emotional. What I meant by that line was that I’d worked so hard to try to do a good job, for nearly twenty years, but it felt like it counted for nothing in the end because no one cared. All they wanted to see was boxes being ticked.

I wished I’d packed a pair of sunglasses to hide behind.

But there was nothing I could do about it now. My opinions were in black and white for all to see. The best thing I could do was straighten my back and get on with working out my three weeks’ notice at the practice.

I was yo-yoing back and forth between anger and regret again. It wasn’t a healthy place to be and thank goodness I had a half-hour break in my schedule. I grabbed my bag and made a run for some fresh air.

Everywhere I looked I was reminded of what I was losing. As I walked through the waiting room, I could feel dozens of pairs of eyes staring at me in disbelief – the leaving letter I’d written to patients was pinned to the notice board.

I crossed the tree-lined street to the coffee shop opposite the surgery, but the atmosphere in there wasn’t much better. Sandra, the pharmacist from the chemist next door, was in front of me in the queue. She’d been dispensing medication as long as I’d been a GP in the area. I thought she was going to mention the article, but she had other news for me.

‘It’s as if the village is in mourning,’ she blurted.

Sandra had become a close friend over the years. She had the kindest face, which was framed by her masses of chestnut hair. She wasn’t much over five foot tall, and looked up at me with her dark eyes.

I couldn’t respond. I had no idea what to say. She carried on, every word tugging at my heart.

‘Your patients are so sad. They don’t know what they’re going to do without you. Amanda, do you really have to go . . .?’

I gently squeezed Sandra’s arm. Really I wanted to throw my arms around her and give her a bear hug.

‘I’ve made my decision, and I’m just going to have to see it through now. I feel terrible though,’ I admitted. The urge to cry rose up in me. That was the last thing I needed: to burst into tears in the middle of a coffee shop queue.

Then came the big question. ‘But what will you do now?’

Well, yes, what indeed?

‘I guess with your experience you could easily get a job in another practice,’ she continued.

That was the last thing I wanted. I’d be faced with the same problems, just in a different location. But what was I going to do? I felt like I was going through a bereavement. I felt sad, lonely, lost, unable to see a way forward, a thick dark fog of self-doubt and guilt obscuring my vision of the future.

Suddenly, the roasted aroma of coffee beans smelt acidic, nauseating and unbearable. The sounds of the café, the white noise of chatter, the hiss of the milk steamer . . . It all felt more than I could bear. I felt waves of heat rush up my neck and I was desperate to return to the chill of the winter air outside.

It was torture. What had I done?

‘I’m going to have to get back to work,’ I said to Sandra.

‘But you haven’t even had your coffee. We have to do drinks before you leave . . .’ Her voice trailed off as I gave her the thumbs up and dashed for the door.

Outside, I took a few deep gulps of air, drinking up the freshness in place of my coffee. I felt like crying. It was all too much. Seeing my outburst in the magazine, hearing how my patients were feeling and then, of course, the final panic: the realisation that I didn’t have the faintest idea what I was going to do with the rest of my life.

Back inside my consultation room, things went from bad to worse when Mr Collins knocked on my door.

If only I could have hidden behind my desk for the afternoon, but there was no getting away.

‘Come in,’ I said, hiding behind a cheerful voice.

Brian Collins was one of my long-standing patients. He was 56 years of age, tall, with grey receding hair, and was always clean shaven. He had long spindly fingers that always made me think he should play the piano.

Brian poked his head around the door and gingerly made his way across the mottled carpet towards my desk. His steps were uncertain; a man whose confidence had taken several knocks.

He’d been on and off antidepressants for as long as I could remember. They eased his depression, but then he would stop taking them, convinced he was feeling better, only to fall back into a depressive slump.

Brian was typical of so many of the patients I saw at my practice. Wealthy, successful, middle class, well-spoken. The stereotypical pinstripe-suited man who travelled into the city every day. When I’d first started working in the area, he was the type of man I must admit that I felt a bit intimidated by, as I thought they might not trust a young female doctor. But, to my surprise, I managed to win him and many other patients over. I think as much as anything else it was by showing them that I really cared about them. I’ve always believed that the root cause of many illnesses can be found in the emotional problems that lie bubbling underneath. The problem then became that many of my patients seemed to depend on me as a counsellor, more than as a doctor . . . Mr Collins was no exception.

‘What can I do for you, Brian?’ I asked, my voice gentle, warm, doing my best to set him at ease.

His eyes were downcast as he slumped into the chair opposite.

‘Is it really true you’re going?’ he said, his eyes filled with worry.

It was the first time I’d come face to face with the effect my departure was having, and it was unbearable. The tension in my little consultation room was palpable.

‘Yes, I’m afraid so.’

He fell completely silent for a moment, staring, intently, at one spot on the carpet before finally looking me in the eye. I could see the tears. It was heartbreaking to watch.

He tugged free a tissue from the box on my desk and dabbed the corners of his eyes.

His voice trembled. ‘But what will I do without you? You’re the only person who understands what I’m going through, and I find it so hard to open up to people.’

His fears were completely natural, and were shared by many people who might feel anxious about changing their doctor.

‘Will you be moving to a surgery nearby?’

I opened my mouth to speak, but nothing came out. I was going to tell him no, but the question had thrown me – all the way back into that pit of uncertainty. I swallowed hard and whispered. ‘I don’t think so.’

His eyes dropped again, crestfallen, and then he suddenly lurched onto his feet.

He shot out his hand, as I imagined he had done hundreds of times in his board meetings, disguising his distress with formality.

‘Well, I wish you all the best for the future, Doctor Brown.’

I felt a lump rise in my throat as I shook his hand.

‘You’ve been wonderful and I really appreciate everything you’ve done for me over the years,’ he carried on in his rigid, staccato voice. ‘And anyone who has you as their doctor next is blessed.’

I bit my lip – hanging on by a thread to stop myself breaking down in tears. Hiding behind my medicine, I told Mr Collins to continue with the same dose of antidepressants, and to review how he felt in three months.

I walked him to the door and we had a moment’s silence, both aware of each other’s grief. ‘Things will get better,’ I encouraged.

With that, he slipped out of the door and I broke down, the avalanche of the day’s emotions crashing in on me.

It was no good; a doctor’s life is a constant flow of difficult situations, of emotional patients, of pain and sadness and death. I needed to be stronger than that – I was stronger than that, always had been – but I just couldn’t see how I was going to get through the next few weeks.

My phone rang.

I wanted to leave it ringing, and I almost did, but I needed something – anything – to pull me out of the low mood I was descending into.

‘Is that Doctor Brown?’ asked a voice on the line.

‘Yes, who’s speaking?’

‘It’s Doctor Phil Burn here. I saw your story in Pulse.’

My stomach lurched.

‘I’m recruiting doctors to work in prisons in the South East of England.’

‘Sorry?’ I wasn’t sure I’d heard correctly.

‘I’m looking for a doctor to work in a prison,’ he repeated.

I was stunned by the thought. I had been so locked away in my village practice that alternative placements like he was suggesting hadn’t really occurred to me.

Dr Burn continued to explain the job. It was a part-time position at a youth prison for 15–18-year-olds, HMP Huntercombe in Oxfordshire, not too far from Henley-On-Thames. ‘Would you be interested?’ he asked.

The thought of prison conjured up images of fights, stabbing, hangings – the horror often portrayed in films. Could I really see myself working in that world?

On a deeper level, of course, I knew that my immediate mental image of prison life could hardly be accurate. And I needed to do something . . . Something new, something that would challenge me, something that would make all of this feel worthwhile. Something that might help people.

‘Yes!’ I said, actually shocking myself. I hadn’t given myself time to think deeply, I was relying on gut instinct, I had no idea what the salary was, I should have been asking so many more questions . . .

But how bad could 15–18-year-olds be? My boys, Rob and Charlie, were that age, so hopefully I would be able to relate to the inmates and perhaps they would view me as a mother figure and not a threat.

Had I really been that naïve? Yes. But I would learn.

He went on to explain that not many doctors wanted to work in prisons, as it was seen as an intimidating and unpleasant environment, dealing with difficult, unwilling, unpredictable and possibly violent people.

‘But’ – and he laughed as he said it – ‘anyone as outspoken as you should be able to handle a challenge!’

I couldn’t believe it, my candid words in the magazine had opened up a whole new world of possibilities. Dr Burn had recognised the fighting spirit in me.

Just because I was nearing fifty, why shouldn’t I try something new? It’s never too late to start over. Whether it be your career, your marriage, your lifestyle. That’s what I’d been telling my patients for years, and now it was time to embrace the unknown myself.

And maybe I could even make a difference to these boys’ lives.

*

Dear God, what have I done?

Back at home, I was questioning my decision. Had I been rash, accepting a job I knew practically nothing about?

I was sitting at the kitchen table doing some background reading into Huntercombe prison.

It was officially classified as a young offenders’ institution, having housed teenagers since 2000. It had originally been built as an internment camp during the Second World War and was turned into a prison in 1946.

Unlike adult prisons, which are categorised by letters, from A to D, depending on the seriousness of the crimes of the prisoners locked up, a young offenders’ institute has no grade. That didn’t reassure me though.

I’m not frightened easily, but I was filled with self-doubt as I read up about the crimes some of these teenagers had committed. It wasn’t just theft and burglary but also murder and rape.

I turned to David for advice.

‘Do you think I can do it?’ I asked

He was peeling the spuds for dinner and laughed. ‘Don’t be ridiculous, of course you can, you’re more than capable.’ He smiled. ‘You always are.’

I loved the fact that he was so supportive of both me and my career. God knows how many evenings he’d spent alone, looking after the boys while I’d worked very long days or been called out in the middle of the night. He understood my drive and my need to help others. He understood I had worked too hard for my career to give it up.

‘I’m going to be treating teenagers who have committed some very serious crimes!’

It was hard to comprehend that boys my sons’ age could have killed someone, raped someone, abused a young child.

‘But they need a doctor, too. And I can’t think of a better person for the job,’ David said.

He was right. I wasn’t there to judge; my job was to try to make people better.

‘But it’s a prison. Have I got the guts to handle it?’

I heard the plop of another peeled potato being dropped into the saucepan of water, then David turned around and looked me in the eye.

‘Do I have to remind you of some of the brave things you’ve done in the past? Do you remember that bloke who had a knife to his throat . . .?’

Chapter Three

Four years earlier . . .

Buckinghamshire

July 2000

It was a scorching summer’s day and I was sipping on an ice cold drink and having a quick bite to eat at my desk in my lunch break.

A gentle breeze lifted the curtains as it blew into my consultation room, tickling the back of my neck.

I battled to keep my eyes open; in that heat I could easily have dozed off for a few minutes. Suddenly the peace was broken by screaming and the sound of footsteps hurtling down the corridor.

My door burst wide open. One of my patients, Jenny Scott, was standing in front of me, breathless, panic stricken.

‘Amanda, you have to come with me now,’ she screeched.

Her normally perfectly styled hair was windswept and tangled. Her usual composure was shattered.

‘It’s Jonathan – he’s got a knife and he says he’s going to kill himself. I don’t know what to do. He’s at home . . . please come.’

Jonathan was Jenny’s husband, an alcoholic who suffered from severe mood swings. I’d been treating both of them for years. Without a second thought, I grabbed my bag, filled with all the equipment and medicines I carry to my home visits, and chased after her into the surgery car park.

She sped off in her car, but I knew exactly where to go. I’d been to their house on many home visits in the past.

It was less than five minutes from the surgery, in a pretty lane with beautiful houses on either side. Large homes, with large gardens and expensive cars parked in the driveways. Many people would look at the area and think that the people who lived there surely had to be happy. But, from my experience, inside many of those magnificent houses, behind the seemingly perfect façades, there lurked a lot of anguish and unhappiness. A significant proportion of the medical problems I treated were brought on by stress and financial pressures. I learned early on in my career that money very often doesn’t buy happiness

Turning into their road, the dappled sunlight trickling through the trees was replaced with the blue and white flashing lights of several police cars. They were parked outside the Scotts’ home. Half a dozen armed police officers wearing protective vests surrounded the house. I parked and got out of my car. What had I walked into? It looked like a hostage negotiation scene from a film.

Jenny was standing behind one of the police cars. She beckoned me over. A police officer stepped into my path, his hand outstretched, ready to stop me.

‘It’s okay, I’m his doctor,’ I explained.

The police officer moved aside and Jenny ran forward, a look of relief washing across her face.

‘Thank God you’re here, Amanda.’

Her whole body was trembling, but she wasn’t crying. Jenny was a tough, resilient woman, and could cope with a great deal. Goodness knows she’d had to over the years. It wasn’t uncommon for Jonathan to lose his temper, but I never thought I’d see the day when police cars were parked outside their house.

‘So, what’s happened?’ I asked.

‘I don’t know, I don’t understand, one minute he was fine and the next . . .’ Jenny paused to compose herself. ‘We were having lunch together. I got up to get the salad cream out of the fridge and noticed three of the wine bottles were missing. Three!

‘I know he likes to drink, Amanda, but three bottles by lunch was a lot even by his standards. I was tired, I was angry, and I asked him where they had gone.’

Her voice started to tremble and, knowing Jenny, she was blaming herself for whatever happened next.

‘He started shouting that I shouldn’t have asked him, and the next thing I knew he’d pulled the carving knife out of the drawer and was holding it against his neck. He was telling me he didn’t deserve me, and he was going to kill himself.’

She looked to me for reassurance. ‘This is my fault, isn’t it?’

I squeezed her arm. ‘No, Jenny,’ I stressed, not for the first time. ‘This is not your fault.’

I felt deeply sorry for her. I couldn’t imagine what she had suffered over the years. And being the strong, independent woman that she was, I imagine she had kept a lot of her pain locked up inside. I also felt deeply sorry for Jonathan, living with anxiety and depression, turning to alcohol to numb his pain.

‘I tried to get him to put down the knife,’ she said. ‘But that only made him hold it closer to his neck. I was terrified, so I ran. He listens to you, Amanda, please will you talk to him?’

I felt the pressure building.

I turned to one of the police officers and asked if they had approached Jonathan.

‘Not yet. We have to wait for legal authority to enter. Won’t take long but right now . . .’ He shrugged. ‘Well, we’re stuck here.’

‘What about me?’ I asked. ‘Can I go in?’

‘Legally? Yes, you’re his doctor, and have reason to assume he may be hurt.’ He looked at me and the fear in his eyes, the concern for my safety, nearly changed my mind. ‘You shouldn’t, though. You should wait for us to get clearance and then we’ll all go in together.’

But that was no good, was it? Jonathan needed me. Jenny needed me. It was my job to help and I was obliged to carry out my duties.

I walked up the driveway.

The Scotts’ house was very beautiful, with a large weeping willow in the middle of the lawn, and flowerbeds filled with stunning roses and brightly coloured summer flowers. Rectangular flowerboxes hung along the wall by the front door, and flowerpots filled with pansies and lavender lined the driveway.

My heart pounded as I drew closer to the porch. I was nervous about what to expect on the other side of the door. There was a chance Jonathan could turn the knife on me.

It felt like one of the longest walks of my life. I turned back to see everyone’s eyes watching me. Jenny’s hand was clutched over her mouth and the police officers were poised, their hands hovering over their weapons, ready to jump in at any moment.

I took one last look back and then plunged in.

The front door was ajar. I pushed it open with my fingertips, stepping into the hallway. The house was eerily quiet, my shoes sounding far too loud on the wooden floor.

I called out. ‘Jonathan?’

Silence.

‘Jonathan, it’s Doctor Brown.’

There was still no reply but I kept moving, into the kitchen, bracing myself for what I was about to see.

But he wasn’t in the kitchen any more.

I called out, again. ‘Jonathan? It’s Doctor Brown. I’ve come to see if you’re okay.’

I heard a noise coming from the living room.

The nervousness I’d felt had left me now. I needed to find him as quickly as possible. I moved into the living room.

‘Oh, Jonathan!’ I gasped as I turned the corner.

He was standing in front of their leather sofa, his slim frame outlined by the sun streaming through the skylights. The knife, pressed hard against his throat, was glinting. He was swaying slightly, drunk, a sweat glistening on his forehead, his lips wet.

He stared at me, not saying a word.

I was shocked. I knew him well, as he had confided in me over the years about his problems, and I’d come to regard him more as a friend than a patient. My heart went out to him that he felt so desperate he wanted to kill himself.

His lips were white, his face drained of colour. His eyes were agitated, his whole body tense. But still he didn’t speak; he just kept the knife clamped to his throat.

I didn’t have any choice but to try to take it from him.

I started to gently walk towards him. My voice was soft as I said, ‘Please, please, Jonathan, give me the knife.’

He was frozen to the spot.

‘Let me have the knife, it’s going to be fine.’

Still no reply, as I softly, slowly moved forward. What was going through his mind? Was he about to cut his own throat? Was he about to turn the knife on me?

The sound of police radios and talking were coming from outside the window.

I couldn’t see any lacerations on his neck, but the tip of the knife was pressing hard against his skin. Any trigger could set him off.

‘Jonathan—’ I started, but didn’t finish my sentence. Suddenly, he lurched towards me, the knife in his right hand.

It all happened so quickly. I froze, suddenly certain that I’d made a terrible mistake, that I was going to die, there in that opulent living room. Blood spilling onto a carpet few could afford. I’d gone there to help but Jonathan was too far gone, too lost to see clearly. His arms stretching out towards me, the knife shining, looking sharp enough to cut a slit in the air itself.

Yes. I was about to die.

He flung his arms around my neck and flopped onto my shoulders, letting go of his grasp of the large carving knife. It made a small thunk as it dropped onto the living room floor behind me. Part of my brain heard it fall, recognised that the danger was past; the rest of me was occupied with the sobbing Jonathan. I stood there, holding him up, as he sobbed and sobbed and sobbed.