In theory, Andrew’s appointment book allowed for him to take a lunchbreak of half an hour, but theory can evaporate in the face of reality. Frequently his break for lunch was gobbled up by going over time with some appointments or using the break to return phone calls that he felt shouldn't wait.
He had personally drawn up his own timetable and he wryly noted that there were occasions where an outside observer would have expected him to be in charge of his scheduling. However, to Andrew, it often felt as if the timetable controlled him, and for a long time it remained unaltered in spite of feeling that it wasn’t working out.
Today he decided to take charge and managed to secure his lunchbreak by taking himself down the street to buy his lunch, choosing some sandwiches together with a coffee. On most days he had brought the traditional paper bag lunch to work, and when possible, ate it at his desk as he wrote notes and made phone calls. He now realised that the only way he could secure a break during the day was to leave the building. He chuckled to himself how something that was bleeding obvious had felt like a revelation.
As he left the building and closed the door behind him, he became aware of a prickly discomfort, as if he was a truant wagging school, and realised guilt was at play, and uncertain why.
Just before he left his medical rooms, Andrew asked his secretary Rosemary whether he could get her anything down the street and told her he'd be back in time for the next patient. Rosemary had been with him for close to ten years now, and he felt she was a wonderful secretary, admired by both his patients and himself.
Years back, a work colleague had told him that the criteria for picking a perfect secretary was to find a middle-aged woman, possibly in her mid-forties, someone who had never married and wasn't in any current relationship – a “spinster”. God, Andrew hated that term – single men didn't have a label put on them.
‘You need to find a single woman who is generally unhappy in her personal life and would be married to the job,’ came the unsolicited advice from his colleague. At the time Andrew thought these comments were cynical and in poor taste, and he continued to feel that. Yet Rosemary in fact did fulfil those criteria, and Andrew reflected on how unfair life could be, as Rosemary showed so much warmth in her dealings with the patients, and yet, away from work, this warmth dissipated in the barren waste that was her personal life.
1.41 p.m.
Andrew seated himself at the back of the local coffee shop where he was able to observe the other people and not be disturbed. He had always enjoyed watching people and their interactions. The waitress brought the sandwich and blueberry muffin that he had ordered, as well as a strong coffee. He thanked her politely before opening a copy of the Sun Herald that he had picked up from the counter. It was not a paper he rated highly and felt it was a rag, but ease won out over content, as he found the page size a lot more comfortable to read.
Not like some of the other daily papers where turning a page might cost you a coffee, accidentally knocked over, or impair the vision of the person sitting next to you.
On page 4 of the paper, he noted an article by Penelope Dee, who was distinguished by the title of “Investigative Journalist”. This label provoked a knee-jerk cynicism in Andrew as he had the impression that a lot of contemporary journalists cannibalised material from other outlets, often rehashing it and then presenting it as the fruit of their own labour. He reflected to himself how journalism was no longer seen as a noble profession by many in the community.
Personally, he conceded that there were a number of admirable journalists still around, but like many, he had the tendency to lump them all together and to judge journalism by the lowest common denominator.
What commanded his attention now was Dee’s article describing how many young females, often university students, worked as strippers or prostitutes to raise the money required to pay for their keep and ongoing education. The article alleged that in some brothels up to 50 per cent of the prostitutes working there were students.
Andrew could accept the premise that some female students did use prostitution as a source of income, but he strongly doubted the high percentages given. And at what price? he wondered.
It worried him about the possible long-term harm to these young women, risking the distortion of how they viewed men and even how they viewed themselves. The strength of his opposition to such practice was unclear to him, as the article presented many of these young women making a free choice, yet it left him feeling uneasy. He had often reflected on the complex force that sex could be. It could form part of a loving relationship, or it could be used for control. It might be a way of obtaining reassurance about one's self-worth, or used manipulatively to climb the promotion ladder at work. It could be used as a means of escaping poverty, or to feed a drug addiction. In fact, the range of outfits that it could be cloaked in resembled a Dulux colour chart of reasons and emotions.
Given all the above scenarios, Andrew couldn’t help wondering whether one should really be judgemental about the use of sex in prostitution compared to all the other ways that sex was used. Still, none of this took away the discomfort he experienced about the idea of university students using sex as a means of paying for their studies, given that most were not escaping poverty nor caught up in drug addiction or sex slavery.
He noted with a sardonic smile that medicine was often shifting from full time employment to sessional work, something that the so-called “oldest profession” had been doing for a long time.
He glanced at his watch and was startled by the time, realising he had better rush back as his next patient was due at 2 p.m. and there were only two minutes to go. Once again he had been kidnapped by his meandering thoughts. He phoned his secretary to warn her he would be at least five minutes late, and asked her to let his next patient know.
Not for the first time, he reflected about the difference between his practice and that of some of his colleagues in other specialties, where multiple bookings for the same time were not unusual. This certainly maximised the time efficiency for the specialist without any apparent concern that patients might have to wait one to two hours to be seen. By contrast, some of his patients would complain if he was over five minutes late. He could understand how patients objected to having to wait one or two hours, as they felt it showed a lack of respect towards them.
2.16 p.m.
As Andrew sat listening to his first patient after lunch, a Mr R, he found himself struggling to maintain concentration, as a wave of drowsiness started to envelop him.
The strange part and one that he didn't fully understand was that there were three other patients in his practice who appeared to have the same effect on him. He would struggle to listen carefully to what they were saying, a feeling he owed that to all his patients. Lately he had given a lot of thought to possible reasons for this, and excluded the possibility of it being caused by a lack of sleep the night before or a heavy meal or other factors along those lines. If it wasn't a factor within himself, he wondered, then what was causing this effect?
It troubled him that he had to struggle to listen carefully to what these patients were saying. It wasn't that these few patients spoke in monotones or that he found their histories boring, so why was there this impenetrable screen forming, creating a barrier between the patient and himself. He had begun to suspect these patients were coasting, and comfortable in not working on their problems. He heard them comfortably describing the same problems each session, appearing untroubled by their lack of progress. Rather, they appeared to be comfortably slipping into a groove where they recited the same problems in the same manner each session, without any sign of being troubled by their lack of progress. There was undoubtedly a level of frustration that he experienced, and probably, like those patients, he was becoming detached from their real issues. He knew that if he was going to be of benefit to them in therapy, he would need to start sharing his observations about their lack of progress, and their inclination to see themselves as victims, whilst they appeared to be only paying lip service to working on personal change.
Andrew was aware that it was easy as a therapist to be seduced into keeping a patient comfortable and winning their approval by just coasting along, but he also knew that the sessions would become meaningless