driven to distraction

At the end of yesterday's surgery I was asked to field a phone call from a patient asking to speak to a doctor about her anxiety state. I consulted the notes before ringing her back and found she has generated an enormous amount of work for my colleagues since Christmas. 24, married, she lost a grandparent and a sister some years ago and, to summarise, had never adjusted to their deaths- a "morbid grief reaction" we might call it.

Something must have happened around last Christmas time, because she suddenly got a lot worse. I noted she had received all sorts of help from counsellors, psychotherapists, psychiatrists and (perhaps ominously) other less conventional healer types, including ones with christian backgrounds and even someone who "channelled" her dead relatives. What more I could add to this panoply of help that had clearly done no good thus far, I who had never even met her, was not clear, but I dialled her number and she picked up straight away. There then followed a 30 minute conversation where I did my best to give some common sense advice to a person who in no way understood the nature of her problem and worse, was in a serious state of denial as to its origins.

Every suggestion of mine (such as "I'd just kick back this afternoon; stay in, take some of your emergency stash of diazepam and watch mindless tele") was questioned, very politely rejected or forgotten about no sooner than I made it. For instance, just moments after I had offered the piece of advice offered earlier, she asked "So, do you think I should go to the gym, then?"

But I had resolved not to truncate the conversation, but to "let her run out of steam". This proved, for me at least, to be a disastrous error. For when the dialogue finally came to a natural end I found myself completely drained, and indeed have not yet fully recovered. My wife, as so often, provided a possible explanation. Now I work only 1 day a week, I have allowed my usual emotional defence ramparts to fall into disrepair, rendering me vulnerable to emotional damage. In an earlier incarnation I would have decided after 10 minutes (as I did yesterday) that the conversation was going nowhere and instead wind it up quickly with "I'm so sorry, I have to go, an emergency call has come in and I must deal with it now."

As it was, although she thanked me effusively for my help, saying something like "You're the first doctor who's ever really listened to me", I felt so angry with her I could have slapped her from here to Tuesday and screamed at her: "Look. You want to talk about loss? Let me tell you about loss. This isn't about loss, it's about that loss throwing your own fear of death into sharp relief. So let's cut the bullshit and get on with our lives, shall we?"

I must protect myself more carefully in the future. And what did happen around Christmas that plunged her into that crippling spiral of fear and panic? I never did find out...