“No good deed goes unpunished”

Actions intended to benefit other people sometimes backfire. They may be perceived as interfering and controlling, or even have tragic results.

I’ve been thinking about this since watching a brilliant performance of Verdi’s Il Trovatore by NZOpera and the Auckland Philharmonia Orchestra. In the melodramatic plot, set in fifteenth century Spain, Count di Luna is obsessed with the heroine Leonora. But she is in love with Manrico the troubadour, and spurns Luna’s advances. There is bitter rivalry between the two men and eventually Luna gets Manrico imprisoned and condemned to death. Leonora, in what she sees as a noble sacrifice, offers herself to Luna if he will spare Manrico’s life. But when Manrico learns of Leonora’s plan, instead of being grateful he is disgusted and appalled, and denounces her. Meanwhile, rather than give her body to Luna, she has taken poison. Manrico is executed, and Leonora dies.

The old adage “No good deed goes unpunished” often applies in real life. During 2020 and 2021, the New Zealand government responded to the pandemic by imposing a strict system of lockdowns, mandates and border closures to protect the health of the population. These well-intentioned policies did limit illness and death from Covid in the short term, and gained admiration from around the world. But were they justified when weighed against the long term costs? Businesses failed, unvaccinated workers lost their jobs, other diseases went undiagnosed and untreated, old people were confined indoors and prevented from seeing their relatives even when they were dying. Despite continual exhortations to “be kind”, ugly rifts developed between those who supported the restrictions, and those who resented losing the freedom to direct their own lives.

On a more everyday level, think of the dinner guest who volunteers to do the washing up, only to put things away in the wrong place and break the host’s favourite mug.

My conclusion? It’s good to offer help to other people – but only if it’s done with unselfish motives and if they want to be helped.

Memoirs of an Oxford medical student 1967-70

Osler House, Woodstock Rd

More than 50 years after graduating from Oxford University Medical School, I found a boxful of letters and diaries which I had written during my clinical course. To a naive 20-year-old from a rather sheltered home background, whose first degree at Leeds University had involved more work than play, life in Oxford was a revelation – intellectually, socially and emotionally. My memory for the past is fairly patchy and though I clearly recall some of the people, places and events described, I have forgotten many others which were obviously significant at the time. I was known by my maiden name, Jenny Collins.

The course was mainly based at the old Radcliffe Infirmary in Woodstock Rd. For some attachments we visited the Churchill Hospital, where I would later become a junior doctor and eventually a consultant, Cowley Road Hospital, and the Nuffield Orthopaedic Centre. The Radcliffe Infirmary was closed in 2007 and its site is now occupied by university offices. The hub of student life was Osler House (not to be confused with the present clubhouse of the same name on the John Radcliffe site) an 18th century listed building in the hospital grounds. Downstairs was a lounge, bar and kitchen. Morning coffee and afternoon tea were provided free. Upstairs were bedrooms for use when on call. There was an attractive garden with a croquet lawn. Each student also had an attachment to an Oxford college – mine was Somerville – but being postgraduate did not live in. My first few months were spent lodging in Summertown with the mother of a family friend, the widow of a bishop and a keen supporter of Moral Rearmament. After I had moved into my own flat, my former landlady continued to invite me for dinner on Sunday evenings.

Our intake contained only 18 or 20 students. Being divided into even smaller groups for clinical attachments, we got a great deal of individual attention from our teachers. For me, as one of the few women in a male-dominated environment, this was often of a kind which would not be tolerated nowadays. As well as clerking patients we were given considerable responsibility for practical procedures such as taking blood, putting up drips, lumbar punctures, delivering babies, and assisting with surgical operations.

There were periods of intense activity – on take for medicine and surgery, night deliveries in obstetrics, preparing for exams. But otherwise the pace of work was fairly leisurely and allowed time for a vibrant social life. Lunches, dinners, parties and outings were frequent and usually involved vast quantities of food and drink. I sang in the hospital choir and in my final year played a good fairy in the students’ pantomime, Tingewick. I must have done a certain amount of studying but most of my free time seems to have been spent entertaining friends for supper or afternoon tea, making my own dresses, listening to pop music, or walking around Oxford which was then a peaceful place with few cars. Several of my friends did have cars, and when they were driving north would give me lifts home at weekends. It was a privileged and mostly hugely enjoyable life which, I imagine, was far more relaxed and informal than for clinical students today.

Much of what I wrote is too trivial, personal or libellous to publish, but maybe I will adapt some extracts for a series of blog posts, a memoir of a novel. Meanwhile I’d be pleased to hear from anyone who remembers those times.

On the other side of the (medical) fence

Since retiring from medical practice I’ve exchanged the role of doctor for those of patient and of patient’s wife, and being on the other side of the fence has been an interesting experience. Between the two of us, my husband and I have needed to see a good many different healthcare professionals from various specialties in recent years. Most of them were excellent, but a few were unsatisfactory and this was usually because of their poor “communication skills”.

Following the retirement of the family doctor we had known and trusted for a long time, I saw a GP whose failings included a rude manner, ordering me to take a long-term prescription for a new drug without any discussion of its efficacy and side-effects, and – as I discovered later – referring me to a hospital clinic without telling me. After that I changed to a different practice and am very happy with my doctor there, but my experience with the previous one distressed me for a long time, illustrating the importance of a good therapeutic relationship not only for improving patients’ emotional well-being, but for influencing their compliance with treatment and the outcome of their disease.

I don’t remember having any guidance about how to relate to patients when I was at medical school in the 1960s, nor during my junior doctor posts. Senior role models varied greatly in their approach, ranging from the caring and compassionate to the arrogant and disrespectful. In the later years of my career this aspect of clinical practice began to be taken more seriously, led by specialties such as general practice, oncology and palliative care. Communication skills training is now included in the education of doctors, nurses and other healthcare professionals, though its long-term impact must be difficult to measure, and depend on the student’s personality. The skills may come naturally to those who have chosen their career for humanitarian reasons. Those who are mainly interested in the scientific and technical side, or whose prime objective is making money, may pay little attention to such “soft” subjects in the curriculum.

The basic principles should be obvious, simply involving courtesy, common sense and genuine concern for the patient. Giving a polite and friendly greeting. Meeting in a clean and tidy consulting room free of interruptions. Listening to the patient’s story with genuine interest and empathy. Taking account of the patient’s knowledge and preferences when discussing management of the problem.

Conducting the interview becomes more difficult in the case of a serious condition. The medical literature contains many studies about techniques of “breaking bad news”, usually in relation to a cancer diagnosis, and I won’t attempt to detail them all here. Key points include giving truthful information without destroying hope. And avoiding dogmatic statements about prognosis, because the outcome in individual cases can vary so much from the average. Negative predictions can be self-fulfilling as well as disheartening, whereas except in the most dire situations there is always some help to be offered, and some scope for improvement. Another point highlighted by our recent experiences is that illness can be just as stressful for relatives as for patients themselves.

My Author Bio

I have just turned 75, and it feels like the right time to review my long and winding journey to becoming an author.

Writing was my first love and as a child growing up in Kent I produced a variety of short stories and plays. These early works have long since been thrown away and their content forgotten, though I think they usually featured cats and dogs. I did well in English at school and was expected to take a university degree in that subject, but in my teens I developed an idealistic wish to heal the sick. The medical courses at Leeds and Oxford, then life as a junior doctor, absorbed so much time and energy that I never even thought about writing fiction again till years later.

It was after many changes both professional and personal that I decided on a career in psychiatry, and when studying for the postgraduate qualifications I compiled my notes into what would turn out to be my first book. A senior colleague suggested sending it to a publisher. It was accepted, and without any marketing on my part sold well and continued into five editions; by far my greatest commercial success. I moved on to academic posts, involving opportunities for research, writing papers for journals, and medical books relevant to my specialty of the interface between psychiatry and cancer.

In my mid-30s, when finally settled into a contented domestic life, I wrote three novels inspired by my earlier work experience in general practice and in mental hospitals. I enjoyed this tremendously, and given my earlier success with the psychiatry book, I assumed that I would have no trouble getting them published. I was soon disillusioned. Some rejection letters were encouraging but others were not, and I was so upset by one damning verdict that I put the manuscripts aside for 20 years. An overreaction, and I now realise that you can’t please everyone and that even the best of books gets an occasional bad review. Knowing how devastating it can be for writers to receive harsh criticism of their work, I will only review a book myself if I can give an honest positive opinion.

Fast forward to my 50s when, after a rewarding career as consultant in psychological medicine in Oxford, I came to live in New Zealand. Alongside many new interests, I focused on writing and editing. Twenty years later I have a variety of titles, non-fiction and fiction in a variety of genres, some traditionally published and some under my independent imprint of Overcliff Books, listed on my Amazon.com and Amazon.co.uk author pages. My current project is editing my husband’s autobiography. What, if anything, I will write next I don’t know.

Books I’ve enjoyed #10

I had plenty of time for reading during Auckland’s prolonged lockdown and the very hot summer which followed.

First, some popular novels set in the UK. The Rose Code by Kate Quinn, about three young women who worked as code-breakers at Bletchley Park during World War Two, is an intriguing and well researched combination of fact and fiction. Watch her Fall by Erin Kelly is a complicated story which gives insights into the world of ballet, and after reading it I will watch Swan Lake with new eyes. The Black Dress by Deborah Moggach, an elderly woman’s quest to find a new man after being deserted by her husband, is full of dark humour and was described in The Times review as a “deliciously savage tale of sex and death”. And Greenwich Park by Katherine Faulkner is a psychological thriller in which a pregnant woman’s life is disrupted by the stalker she meets at an antenatal class.

Next, a small selection of the many books recently published by members of the Auckland Crime Writers group. Blood on Vines by Madeleine Eskedahl, Quiet in her Bones by Nalini Singh and my own novel Cardamine are all set in New Zealand and evoke the local scenery of forests, beaches and vineyards. Some describe other locations. The Girl in the Mirror by Rose Carlyle is set on a yacht, and The Forger and the Thief by Kirsten McKenzie is a historical thriller set in Florence.

Two novels in the literary fiction genre. Klara and the Sun by Kazuo Ishiguro, narrated in the voice of a gentle and observant robot who is purchased as the “artificial friend” of a fragile teenage girl, is a readable story which raises some profound questions. More challenging is We Germans by Alexander Starritt, in which an old man writes to his grandson in an attempt to come to terms with his past as a soldier serving on the Eastern front in World War Two.

Four non-fiction books which left an impression on me. The Devil You Know by Gwen Adshead and Eileen Horne contains a series of (disguised) case histories of psychotherapy with mentally disturbed criminal offenders, not all of whom could be helped. I reread an older book, The Power of Premonitions by Larry Dossey, a physician who has made a detailed study of “psi” phenomena. Against All Odds by Craig Challen and Richard Harris is a vivid description of the 2018 rescue of the young boys trapped in a cave in Thailand. Lastly, Dear John by Joan Le Mesurier is about her marriage to the actor who is still fondly remembered for his role as Sergeant Wilson in Dad’s Army.

Fostering kittens again

Photo by little plant on Unsplash

It’s been a long time since we last had foster cats or kittens in the house, the reason being that I’ve usually ended up adopting them permanently. Having promised my husband that won’t happen again, last week I took in two more from a local animal welfare charity. It’s against the rules to post their photos online so I’ve used a stock image.

My first experience of fostering in New Zealand, over twenty years ago for a different charity, was quite informal. A litter of four small kittens was delivered to the door and I was left to get on with caring for them until they were old enough to be adopted. I kept one, Felix, a dearly loved cat as described in this post.

Nowadays, the role of a feline foster parent is much more tightly controlled. The online application process requires obtaining a criminal history check, answering multiple-choice quizzes based on the content of a 30-page manual, and submitting photos of the proposed foster room setup. After completing it successfully, I got a call from the volunteer coordinator and arranged an appointment to drive out to the nearest rescue centre.

I returned home with two kittens, a black male and a tortoiseshell female. They are about 10 weeks old and before being made available for adoption they will need to complete medication for an intestinal infection, receive worm and flea treatments and vaccinations, and gradually transition to a different diet. Looking after them involves providing fresh food and water, changing litter trays, and sessions of play and cuddles every few hours. I am also giving extra attention to our two adult cats who are being strictly kept apart from the kittens but are keenly aware of their presence. Leo seems frightened of them whereas Magic seems hostile.

Fostering these kittens is a big responsibility and time commitment, but also a delight, because they are as lively and affectionate as can be and it’s going to be hard to give them up.

A canine memorial service

A group of dogs who were bred in Auckland’s Guide Dog Centre meet every week for a “play date” in one of our local parks. Most of them are Labradors, either black or yellow. They include puppies in training, working dogs both active and retired, and those who were withdrawn from the training programme and are living as family pets. I was introduced to this group through Ireland, a four-year-old black Lab in the “withdrawn” category, who is owned by a local family. I am his “dog-sharer” who walks him almost every afternoon, as described in a series of my recent blog posts.

Three of the long-term canine members of the group have died in recent months. Two of them were near the end of their natural lifespan, which for Labradors is 10-12 years. The third, who was a little younger, had developed heart failure. Today we gathered in a beach-side reserve to honour their memories. The weather pattern of sunshine and showers mirrored the bittersweet mood of the occasion. There were tears as each of the bereaved owners delivered a short eulogy to their dog, but there was pleasure in sharing food and drink with friends while watching the younger Labs chase each other round the grass and jump into the water. Like a human memorial service, it was a significant event.

When I lived in England I volunteered with the Society for Companion Animal Studies (SCAS) to provide telephone support to people who were distressed by the loss of a pet. Through that work, as well as through my personal experience, I learned that the death of a beloved companion animal can be no less devastating than a human bereavement. Those who do not love animals find it difficult to understand grief of such intensity, and may make hurtful remarks like “It was only a dog” or “Why don’t you just get a new one”. A lost pet cannot simply be replaced in the same way as a worn-out garment or an old car. Having said that, many owners will find comfort by bringing another animal into their homes when they feel ready to do so.

Ireland visits Mt Cambria (Devonport dog walks #4)

To quote from a local tourist website: “Mt Cambria Reserve is quiet retreat in the pretty seaside town of Devonport. The attractive landscaped garden sits in the remains of Mt Cambria volcano, which was a quarry for scoria rock between 1883 and 1985. Mt Cambria Reserve is situated behind Devonport Museum on 31a Vauxhall Road and is an ideal spot for walks and relaxing picnics.”

Ireland can smell a picnic

Ireland has to be kept on a tight lead when picnics are in progress – like most Labradors he has an insatiable craving for food. But provided there are no picnics, Mt Cambria is a lovely place for dogs to run free. It’s quite a small park, dotted with clumps of trees, and has a steep slope at the back.

Ireland rolling down the grassy slope

From the top of the park is a view of Mt Victoria, another good place for dog walks as described in an earlier post.

A highlight of Ireland’s week is his “club day” when he spends an hour rushing around Mt Cambria with a group of his canine friends while their owners look on.

Writing as an Englishwoman in New Zealand

Here’s a little background to my new novel Cardamine: A New Zealand Mystery. Amazon links: US, UK, AU

Most novels contain elements of autobiography and the setting for this one was informed by my own memories of visiting New Zealand for the first time, discovering the beautiful beaches and countryside, the enticing vineyards and coffee shops. Several North Island locations – Waiheke, Browns Bay, Riverhead Forest, Muriwai – are featured in the book. There are also references to the confusion that can arise from subtle differences in culture and use of language between two English-speaking nations. My background in medicine and psychiatry had an influence on the plot, with speculation about how emotions, beliefs, personality factors and mental or physical illness can contribute to crime.

The main character, Kate, is in New Zealand on holiday on the eve of the Covid-19 pandemic. She is much younger and more adventurous than me but shares my liking for sea swimming and the local wines. After drinking rather too much of them during a vineyard tour, she loses the bag containing her valuables and so misses her night flight back to London. A rich and eccentric elderly man comes to her rescue and invites her to stay in his country house, called Cardamine after the flowers around the pond in the garden. His wife, a “mail order bride”, is mysteriously absent. Kate’s summer holiday had begun as an idyll of sunshine and swimming and budding romance, but she becomes aware that the country’s “clean green” image conceals a darker side involving racial prejudice, illegal drug use and unnatural death.

Cardamine is available in paperback or Kindle format from your local Amazon website: US, UK, AU. New Zealand residents can buy a print version directly from me – please write via my contact page if you’d like to order a copy.