Where doctors cannot reach: tales from a British High Street

Suchita Shah
Oxford, United Kingdom

 

Spring

High Street, Oxford, England, 2018.
Photography: Suchita Shah © 2018 Suchita Shah

“I wonder if it’s contagious?”

In a tiny shop on a middling-sized street in my city, a handful of women and I were immersed in a springtime ritual of beautification and small talk: haircutting. One woman seemed somewhat precious about it. The type, I thought unsympathetically, who would present to my busy clinic with hair loss and I would see nothing except luxuriance, wondering what all the fuss was about. But her voice, which had asked the potentially-medical question, was unexpectedly lowlighted with sadness; instinctively, I went to turn towards it. However, straitjacketed as I was in my black, armless cape (and not a fan of the modernist cut), I resigned myself instead to keeping my head where it was: eyes on the mirror, ears to the ground.

“Three people from my school year have got it. All in our fifties. Can’t be a coincidence.”

They paused, her stylist and she, looked at each other sagely as if in shared recognition of some unspoken causative link, then returned to their respective tasks of sculpting and sipping elderflower pressé.

“It runs in the family, you know.”

Snip, sweep, swish.

“The op and the chemo? Oh, they took it harder than I did.”

My face burned. It was precious, I realized, because it had only just grown back; and with each uncritical untangling of wet diaphanous strand, an unwitting custodian of sorrow had shown she understood.

 

Summer

Round the corner from the hairdresser’s stood the High Street, approximately four hundred yards of terraced retail, where the folk who had not gone on holiday glowed under an elusive British sun. They walked frictionless –heck, they even smiled.

One person was smiling more than anybody else. She entered the first of a strip of charity shops and I followed. Passing a family of decapitated mannequins, she veered towards a rack of very small clothes and started flicking through them. Another woman arrived, navigating a pushchair containing a fawn-eyed, coryzal toddler taking a half-hearted stand against his harness. “When are you due?” she asked the radiant woman.

I was taken aback by the boldness of the assertion. And, as it turned out, its accuracy. But I should not have been. Last week alone, I had referred every one of my female patients, it seemed, for antenatal care; it was just that time of year.

The pregnant woman broke into a smile. “Early days,” she said. And then, more cautiously, “It’s not great timing, my partner just lost his job.”

I felt embarrassed to listen further. As I left I caught whispers of solidarity, practical advice, and offers of tea. From that musty, carpeted little space—that homage to all things preloved—I caught the melody of compassion.

 

Autumn

As the leaves turned russet and gold, I had a rare day off. First, I went to the bank, where I saw: a conspicuously lonely ATM, a muted television screen showing a football match, a wigwam of blue pens stuffed into a pot on a ledge, one teller, and a line of impatiently tapping feet. A kyphotic elderly lady with a tartan shopping trolley was depositing some notes.

“For the donkeys,” she said, as though the connection should have been obvious to anyone of sound mind and moderate intellect. The teller, however, smiled knowingly, having been aware of the equine fund for some time. She asked the lady how things were going.

“Well, it’s getting chillier now, isn’t it? I shall have to put the heating on soon.” By “soon,” I thought to myself, she means mid-February, when she will have exhausted her armoury of woolly jumpers, blankets, and hot water bottles.

She paused, as though about to speak further, but seeing the snaking queue behind her shuffle and sigh, proceeded instead towards the electronic door, grabbing a blue pen on the way.

Later that day, I spotted her in the library, where it is warm and the newspapers are free. She had settled herself into a beige armchair to read one, a suitably bland independent, but on top of her trolley sat “Sod Seventy!: The Guide to Living Well” and, underneath, the barely visible spine of “Fifty Shades of Grey.”

With my hasty catalogue of age and crooked spine, I had wrongly diagnosed decrepitude. What actually sat in front of me was a nimble disposition, whose fingers had staved off arthritis (which made them good at grabbing pens), and whose eyes twinkled mischievously. The librarians, of course, had known this all along.

 

Winter

It was toothachingly cold and the High Street was packed with hurry. To escape the spirit of Christmas, I entered the local church. It was empty inside. I inhaled the silence and took an unobtrusive seat near the large stone font. The chairs interlocked, a ready-made congregation holding wooden hands in unity and prayer. I dreamed. Minutes into my reverie, I noticed that I was not alone.

Several rows across, in the monumental shadow of a pillar, sat an elderly man wearing an old but clean grey suit. He was staring at an alabaster Madonna dressed in navy and gold, her painted blue eyes flecked with prescient sadness as she held her foretold infant in her arms. He looked at her like a lost sailor looks at a lighthouse. As I got up to leave, I caught sight of his face. Startled, I realized I knew him.

Madonna and Child, Church of Our
Lady
, Bruges. Photography: Suchita
Shah © 2018 Suchita Shah

Several months earlier I had been visiting a ninety-year old woman with profuse rectal bleeding, cachexia, anemia, and the strongest desire in the world never to set foot in a hospital. As her family doctor, I was tasked with making her undiagnosed mass as undemanding of her as possible. Every time I went to her home, her husband would be at the door, in an old but clean grey suit and bow tie. No matter what catastrophic medical event had happened beforehand, his sartorial standards never slipped – except one time, when a tiny brown stain on his shirt disclosed a night spent administering to his wife’s capricious bowels. On that same visit, I noticed a framed sepia photo of two young people getting married, the only picture in the flat. Their wartime love could afford each other but not a white dress or morning suit, yet they would be together for sixty-six years, for better or worse, in sickness and in health—that single picture the only material reminder of their promise.

After Mary died, peacefully, I worried about Jack. Over the years he had acquired a generous collection of illnesses, followed by increasing frailty, for which we, his doctors, offered regularly irregular interventions that were, mostly, rejected. Like a broken record our interactions ground to an uneasy, coagulated stasis.

Professionally, I moved on. By the time I encountered Jack again so unexpectedly in the church, he was no longer my patient. But when I saw him sitting there, in peaceful co-existence with that carved symbol of ultimate loving sacrifice, I began to wonder whether I had really known him at all. What had brought him there that day? What were his hopes, dreams, and fears, his joys and regrets? Who was Jack outside my consulting room? I did not know, because I had not asked. Yet, most likely, someone somewhere knew; somewhere, beyond my clinical reach.

I will never forget that wintry day in the church, or those other days when I truly inhabited my community, because I learned something no textbook will tell: that health, ill-health, and healing can and must happen beyond where the doctor goes; they flow, season to season, through the everyday spaces we occupy, and through the people we connect with in these spaces – the priest, librarian, shopkeeper, or curious passerby. That in health, place matters.

I must have started out knowing this, because it seems very obvious, but then I became a doctor, and the center of my world became Medicine, with its designated centers of care. And I assumed that Medicine would also be at the center of my patients’ worlds. The bit I became inculcated to forget was what happens outside hospital and clinic corridors, and how fundamental it is to our health.

The built and natural spaces embedded in our communities are the beating hearts of good health. Populated by informal guardians of joy, sadness, faith, and all other things essential to the human condition, they are the invisible lifelines of the present and future. Yet many of our public and private spaces are dying. In the city where I live, the bank has closed its branch, and the branches that remain have uninstalled their humans in favor of machines. The public library is under threat, no longer deemed affordable for the public purse. Churches have been converted by real estate zealots proselytising efficiency. The hairdresser thrives.

That our surroundings influence our health, and that healthcare alone does not create good health, are time-honored truths which, first having been usurped by modern medicine, are now acceptable maxims once more. Space has a purpose. We need quality space to live, work, play, sleep, age, renew, and connect. We need to preserve our existing healthy spaces, as well as to create new ones. We need our medical institutions, of course, but they must be connected with our everyday spaces – with the communities in which we live. And we need our everyday spaces, along with the people in them, to heal us in a way that doctors alone cannot—to be where doctors cannot reach.

 


 

SUCHITA SHAH, MD, MPH, is a family doctor in England. She also hold degrees in public health and international relations. Her professional interests include primary care, public health, global health, medical education, writing, photography, and the arts.

 

Winter 2018  |  Hektorama  |  Doctors, Patients, and Diseases