“Come on in, Sylvia,” said Emma.
Sylvia sat down. Unfortunately she’d reverted to wearing the same purple dress that she had on for the first session six weeks ago. And the canary yellow bag was still a constant fixture and fitting. Emma started to fantasise about what it might contain. And Sylvia seemed to have lost weight.
“Okay, Sylvia, let’s review what we did last time and the homework I set you.”
Emma heard silence. Sylvia made no eye contact and her head was hanging low. She’d taken several steps backward, by all appearances.
“How are you feeling today, Emma?”
No response.
“I see that you’ve got that nice purple dress on again; does that mean something special for you, Sylvia?”
No response.
“You know what, Sylvia, I’m just going to pop out to get both of us a glass of water and I’ll be back in a jiffy.”
Emma went out to get some water. On her way back she checked through the one-way glass in the door to see whether Sylvia had changed in her posture; she hadn’t. By this point, Emma was getting concerned that her client had become virtually catatonic, which was way outside her comfort zone as a pain physician in training.
Emma went back in and offered Sylvia the water; she reluctantly accepted the cup, and then, slowly and very bizarrely, poured the contents over her head.
Emma bent down and briefly caught a look at Sylvia’s eyes through the dripping curtain of her hair. Emma took a sudden step back and knew that the answer was in that canary yellow bag after all. Sylvia’s SOS message was flashing yellow, white, red…yellow, white, red…
“Sylvia, I think I know now that the answer is in your bag. Is it alright if I take a look?”
Sylvia let the bag slip out of her hands and Emma opened it. Inside she saw something crumpled and white. She carefully removed it and discovered a child’s white dress covered with grotesque splodges of something which she immediately recognized as old, dried blood. Emma gently put the dress and bag on the table and turned to Sylvia.
“Sylvia, I think I understand everything. Now I want you to be brave a little longer and I’m going outside to make a phone call. Do you understand?”
Sylvia looked up and slowly nodded.
Emma went outside and found a phone, keeping an eye on the room where she’d left the door ajar. Sylvia seemed to be staring at the white dress.
“Oh, hello. My name is Dr Emma Jones. I need to report a possible case of rape. Can you get some officers around immediately to the psychology outpatient clinic at the Warneford, please? Great. Thanks.”
Two female police officers arrived at the clinic within half-an-hour. The child’s dress was put into a plastic bag and taken away for forensic examination. The police officers stayed with Sylvia for some time, but she remained in a profoundly retarded state.
Reluctantly, Emma arranged for her to be admitted to an acute psychiatric ward and was relieved to hear that there was a bed on a female only ward. Over the course of a week or so, Sylvia gradually came out of her catatonic state. The story she gave was harrowing in the extreme: years and years of sexual abuse by her stepfather, and being passed around between various men for sex like a pass-the-parcel to be unwrapped and abused. Sylvia’s final tipping point had been a further rape the day before Emma saw her in the clinic.
The white dress proved to have vital forensic evidence on it and the stepfather was subsequently arrested and charged with rape and kidnap. Sylvia never did say how the dress came to be in the canary yellow bag.
September 1996
Emma had just returned from the International Pain Symposium in Oslo and she felt encouraged by the reception given to her poster presentation entitled ‘Visualisation for modification of pain perception’. Although the study was small and hardly up to the standard of a randomised-controlled trial, the results were quite impressive and the paper itself was due to be published in the journal ‘Pain’.
Emma dropped by the canteen to pick up a coffee to drink on her way to the wards. As she was leaving, she heard a voice call out “Dr Jones?” She turned to see where the voice was coming from and saw a good-looking man in his 40s with hair greying at the temples. She thought she vaguely recognised him but couldn’t put a name to the face. As she got closer, she realised that he was Michael Williams’s partner and the person who’d screamed at her in the coroner’s court. Her immediate reaction was to run for the exit but he motioned for her to sit down at the table.
“Dr Jones, I’m just so sorry that I flew at you like that. I’ve felt so bad ever since. As soon as that fucking registrar stood up, I knew it wasn’t your fault. I’m really, really sorry.”
“That’s okay, I forgive you. Grief’s a bugger really. It hits all of us,” said Emma.
Tony put his hand across the table to hold hers.
“Hello, what do we have here?” said a tall man with piercing blue eyes and short blonde hair. “Is my boyfriend going straight on me?”
“No, silly,” said Tony. “This is the doctor I was telling you about: the one I said awful things about in court and made a right fool of myself.”
“I’ve heard a lot about you, Dr Jones,” said Fred. “And whatever Tony said to you in the court, you really helped him move on after Michael’s death.”
Tony nuzzled Fred’s shoulder.
“I didn’t do anything really,” said Emma.
“It was the touch and the look that did it. So, thanks, Dr Jones,” said Tony.
“Thank you, Tony. And I must say I really approve of your choice in men,” said Emma, looking at Fred. “It’s just a shame they don’t make them in a straight variety.”
Tony and Fred laughed and waved her goodbye.
What a nice couple, Emma thought, and she really did wish that a gorgeous man would enter her life soon.
Emma made her way to one of the oncology wards to see a 19-year old man with bone pain following surgery for an osteosarcoma of his leg.
“Hi, are you Julian? My name is Dr Emma Jones and I’ve been asked to help with your pain.”
Julian looked up at her with haunted eyes and she immediately saw that he was struggling to reconcile pain and an uncertain prognosis with a burning desire to get on with his life. It was that positivity which gave Emma some hope that she might make a difference.
“What I’d like to try with you is a way of getting you to take hold of the pain and reshape it using your mind. I hope that doesn’t sound too weird, but I just think it might work.”
“Okay, I guess I’m game for anything,” said Julian.
“Great,” said Emma. Now what we’ll be doing together is called ‘visualisation’. It’s a bit like hypnosis but I promise I won’t make you quack.”
Julian laughed.
“First, I need to get you sitting comfortably. That’s it, good. Now, I want you to close your eyes and start taking some breaths, listening to my voice and your breathing, but nothing else. That’s it: in, out, in, out, hearing your breath and feeling more and more relaxed with every breath. Now I’m going to take you down five steps, and with every step you’ll feel more and more relaxed: 5, 4, very relaxed, 3, listening to your breaths, 2, still so relaxed, 1. And now you’re in a place where you feel so relaxed that you can start helping your pain. So, Julian, I want you to imagine that you’ve got a thermometer in your hand that can read your pain, where red is really bad, orange less bad, yellow even less bad, then green, blue and finally white where there’s no pain at all. Now, Julian, thinking of your pain, can you tell me what the thermometer is reading?”
“Orange,” said Julian.
“That’s good, Julian. Now I want you to imagine that your breath is flowing over the pain and that with every breath the pain is getting better and better and starting to go away. So, in, out, in, out and let your breath cool your pain. So, Julian, can you tell me what the thermometer is reading now?”
“Yellow,” said Julian.
“You’re doing so well, Julian. Perhaps you can try getting it a bit lower than that, so in, out, in, out and let your breath keep on cooling the pain. What’s the thermometer reading now?”
“Green,” said Julian.
“You’ve done really well, Julian. Now I want you to hang on to that green colour and I’m going to take you back up the stairs to the ward and the bed where you are now. And if the pain gets bad again, you can always go back to that place by simply closing your eyes, breathing in and out, and counting down from 5 to 1. And then once it’s better, you can come back to the ward by counting from 1 to 5. So, now Julian, it’s time for you to come back to the ward: 1, 2, you’re feeling more alert, 3, the pain thermometer is still green, 4, 5 and you’re back on the ward and you can open your eyes.”
Julian opened his eyes and Emma saw that the haunted look had gone.
“How’s the pain, Julian?” asked Emma.
“It’s okay. I’d say it’s still a green.”
“Brilliant,” said Emma. “So I want you to use what I’ve just taught you and I’ll be back in a few days to see how you’re getting on.”
Now that was the sort of morning that made Emma feel glad to be alive and definitely put her demons back in the closet.
May 1997
The Witherington Hospital appointments committee collectively leaned back and put their pens on the table.
“There’s no doubt that Dr Jones is impressive, but there’s something a little cold about her,” said the Chairman of the appointments committee.
“I think I know what you mean,” said the Medical Director. “It’s as if she’s examining you and finding all your faults. Which might not be a bad thing, I suppose.”
“Well, her research credentials are excellent – particularly her paper on modification of pain perception – and she’s also a respected teacher,” said the college representative.
“I agree,” said the Head of Anaesthetic Services. ”She’s really got everything we’re looking for and she seems keen on reinvigorating the pain service.”
“Let’s tot up our scores and see who come out on top,” said the Chairman. He turned to the sheets in front of him and did some rapid addition. “Well, there’s no doubt, Dr Jones gets the highest score. Now let me check her references… Yes, all excellent. I propose therefore that we appoint her. Is that acceptable to everyone,” he asked.
The members of the committee nodded and yessed. The chairman got up and went to the door to invite the successful candidate back in.
“Dr Jones, the appointments committee is delighted to offer you the post of Consultant in Pain Medicine,” said the Chairman.
Emma briefly studied the four faces in front of her. “Thank you very much, gentlemen,” she said. “I’m pleased to accept the post.”
“Very good, said the Chairman. “Shall we say you start the first week of August?”
August 1997
Emma’s new office was adjacent to anaesthetics which made sense as pain management is usually the province of anaesthetists. She knew that competition for the job had included anaesthetists, so she was pleased that they’d gone for a physician instead. The office wasn’t big but she didn’t really see herself being in the office that much, as she planned to be highly visible on the wards and in clinics. She’d known the secretary from before when she was a house officer. The two of them had shared looks whenever the Professor’s name was mentioned; his rich tapestry of life was now confined to the golf course.
Emma took a Victorian glass jar out of her bag and put it on the table. She thought she should fill it with sweets or something in case people started asking what it was for.
As well as a secretary, Emma had a small team comprising a part-time physiotherapist, a part-time OT and a session or two from an anaesthetist and a psychologist. In fact, she’d done her own training in CBT and didn’t think he’d add much. Still, all hands on deck, as they say. And Emma quite liked the multidisciplinary approach - as long as they didn’t get in the way. She was the only full-time doctor, which meant that she could be pretty autonomous medically.
So it was now 9:00 a.m., and time for the first meeting with her pain team.
“Good morning everyone,” said Emma, smiling, “I’m Emma and I’m your new boss, or so I’ve been led to believe.” That broke the ice and everyone seemed more relaxed. Glancing around the room, she sensed openness rather than hostility. That goes with the territory, she thought, as pain management attracts certain personalities. “I know that we’ve got to head off to the clinic in thirty minutes, but I just wanted to meet you all so that I can put names to faces and run through a few basic details,” she said.
The team introduced themselves and they each gave a brief resume of their previous experience in the team. The only person new to the team was the anaesthetist and it turned out that he’d been seconded from elsewhere in the service.
“The big difference,” Emma explained, “is that I’ll be working full time. So, when I’m not with you in clinic, I’ll be working on the wards, and hopefully, in the community. I like to see it as going to the pain rather than the pain coming to you.” They all laughed. “And from time to time, I’ll be calling on your services – if you’ve got a free moment, of course.”
So, off to the clinic which was held in the main outpatients block. Emma’s patients were divided up into new patients and follow-ups. The team would meet again at 11:00 a.m. to compare notes and for a quick coffee.
Emma’s first patient was a 70-year-old widower with advanced prostate cancer and bone pain. It had clearly been a struggle for him to get to hospital and hospital transport had been a mixed blessing because they dumped him off at out-patients well over an hour ago. He was already on heavy duty analgesia which was causing other problems like constipation. But looking at him, she could see that there was still a sparkle in his eyes, which made her think there could be a way forward.