6. Into the Unknown
Going to university as a mature student had been hard work but a lot of fun. Lara was only a few years older than most of the other student nurses and their training wasn't like a normal degree course. 50% of the time the nurses did their university work in a building that was a long way from the main university campus. The other 50% of the time was spent in the clinical environment of the local hospital. Lara's university days weren't spent partying and skipping lectures - the workload was relentless and she was soon doing long shifts to gain all the necessary hands-on experience she needed to qualify.
With Neil's salary, savings, some money from her parents and a bursary, Lara and Neil managed to keep their home life relatively unchanged after Lara quit her office job to retrain. A little bit of belt tightening was necessary, but the couple managed to struggle through 3 years without Lara's salary.
Although she avoided living in a dirty and messy student house, Lara didn't miss out on any of the social bonding with the rest of her course-mates. During those three years at university, she made a lot of good friends.
After qualifying Lara's friends had been scattered all over the country. Some of them wanted to specialise. Some of them wanted to get jobs in particular cities or closer to family. There were a lot of jobs in London, which attracted many friends to move there, but Lara wanted to stay in the local area. For a lot of her friends, they were bored of the unremarkable university town they had spent three years in.
Working at a big hospital as a general nurse, there was a lot of variety in the day-to-day challenges. There were a lot of staff. There were a lot of departments. There were a lot of different procedures that could all happen within that large hospital building. The NHS had been closing smaller local hospitals, in preference for larger facilities, so that fewer items of expensive equipment had to be purchased nationally.
One of the few things separated from the general hospitals was mental health care. While the hospital had a handful of mental health specialists, they were in a psychiatric liaison role. Any physical health issues would be treated at Lara's hospital and then the patient would be transferred if they required inpatient care for mental health issues. There was a clear demarkation between general medicine and mental health and the few people Lara knew who had specialised in that area had followed a very different career track from her.
As a medical professional, Lara felt frustrated that she didn't know more about mental health issues and there was little opportunity at work to have a casual conversation with any of the doctors. The doctors in the hospital had specialised in the treatment of physical ailments, disease, surgery. She only knew a few doctors who she should speak to if a patient was behaving strangely. In Accident & Emergency the hospital would treat drug overdoses, alcoholics and people who had physically injured themselves while in a crazed state, quite often accompanied by police officers. The police normally had a better idea of what psychiatric issues the patient suffered from than the hospital staff. It seemed as though the police were at the front line of mental health issues.
Although she had bandaged lacerated wrists and dealt with patients who had swallowed handfuls of pills or poison by treating them with activated charcoal, Lara never really knew the story behind what had brought them to the brink of suicide in the first place, or what happened to them after they were physically healthy enough to be moved to a psychiatric facility. The patient notes for the nurses contained details such as blood pressure and medications. Very few details about the psychological problems that troubled these people were in the notes she saw.
When the weekend arrived, Lara found herself turning to the Internet to find out more about depression and how it was diagnosed and treated. It seemed strange that despite her training and experience, she should have to turn to websites for information, but she didn't know who to speak to. She knew friends had suffered bouts of depression, but it felt insensitive to phone them and say "Hey! You've been down before. What can you tell me?" Those friends who had become depressed never discussed the details of their prescribed treatment openly.
Lara knew her mum had become depressed after giving birth to her little brother. Her mum had sought help from the family doctor. Lara's mum said that a little time talking to the doctor about her feelings had been exactly what she needed. That was over 20 years ago. GPs didn't have much time to talk to their patients anymore. At the local doctor's surgery, Lara seemed to see a different doctor every time she visited.
Therapy conjured up images of whiney New Yorkers, self-indulgently talking about how their daddies didn't love them enough, on a psychotherapist's couch, spending hundreds or even thousands of dollars. Lara thought that to suggest counselling might make Neil more upset. Many people derided therapists as "quacks".
Having spent the week without socialising amongst their usual circle of friends, Lara now faced further isolation all weekend, as the couple cancelled their plans. There was little that Lara could do to help at home. Even asking Neil "are you OK?" could be a barbed question, when clearly he was not. It was very British to say "I'm fine thanks" as an automatic response whenever anybody asked how you were, no matter how dreadful life was feeling at that moment. Neil and Lara's parents had been raised in an environment of post-war austerity, where stiff upper lip and concealment of any inner emotions was considered the preferred way to conduct yourself. The touchy-feely stuff was not dealt with well by either family.
By Monday morning, Lara was relieved to be able to immerse herself back in her work. Throughout her shift she barely had a moment to herself to dwell on personal issues. For the sake of the patients and her team, it was imperative that she was positive and upbeat, concentrating, not distracted. She was expected to be a pillar of strength and exude confidence when patients were scared, in pain and discomfort. Context switching was surprisingly exhausting, but it didn't hit Lara until she left the hospital.
As the week wore on, Lara found that she was less and less able to carry the caring face she wore all day at work into her home. She felt like she had lost the support of both her partner and her social group and she could barely keep her own head above water. By Friday, some tiny slip of the mask must have betrayed how truly drained she felt, because the Ward Manager called Lara into her office at the end of her shift.
"Is everything OK, Lara?"
"My fiancée hasn't been very well for a couple of weeks, but I really didn't want to bring my problems with me to work, Judy, sorry" replied Lara.
"It's OK. You just look a little under the weather. I hoped you weren't coming down with something. Your work has been fine this week. No complaints from me" said Judy.
"Yeah, I'm fine. I'm just going to sleep all weekend and let my batteries fully recharge" said Lara.
"Well, look after yourself. Are you getting the support you need at home?" asked Judy.
"Yeah. We're getting by. I'm sure Neil's going to be feeling better and back to work soon" replied Lara.
"Neil. That was it. I remember you saying you'd got engaged, but I must admit I'd forgotten your fiancée's name. Any news on the wedding?" asked Judy, turning the conversation more light and casual.
"No, we haven't even started planning yet" replied Lara.
"Oh well. No rush" said Judy, glancing down at some paperwork on her desk.
"See you Monday. Have a good weekend" said Lara.
"You too" replied Judy, busily scribbling notes onto a yellow form she had been filling in when Lara had entered the office.
Lara fetched her coat and bag with some sense of relief, but also the nagging feeling that she had somehow trapped herself. Next week at work, she would have to work hard to keep a brave face on things. It would be harder now to admit that she wasn't coping well. All she could hope for was that things would be getting back to normal sooner rather than later.
Anne was hurriedly pulling on her coat as she jogged along the corridor to catch up with Lara, who was making her way to the lifts.
"What was that all about?" Anne asked.
"Oh, she was just asking if I was OK" Lara replied.
"And are you?" Anne asked.
"Not really" said Lara.