What made you want to be a doctor?  

I grew up in a rather isolated country village and quite early in life identified who had the most interesting job out of all the adults whom I had met.  As a result, at the age of four, having carefully considered all the possibilities open to me, I decided that I would become the next village doctor. Everybody was very pleased by this news. That Christmas, having been to the local theatre, I made my second big decision. After a long day, sitting behind that beautiful leather-topped desk, having had to decide whether to give the pink medicine or the brown medicine to all the other children in the village, I was going to walk home to my wife at the sweet shop, where I had planned we would live. She was the kindest and most beautiful person I had ever seen, and by the end of that Christmas performance my future life was mapped out. I turned to my parents as the lights came up and made my big announcement. I was going to marry Snow White. 

Why did you choose your specialty?

I fell into Psychiatry when my wife suggested that, before I gave medicine up forever, I just try this one last specialty, which she believed might finally suit me. After a long discussion we agreed that if this was as miserable an experience as all the other jobs had been and I still felt that I could not bear to go on, we would sell up as I had proposed, pay off as much of our debt as we could, declare bankruptcy and she would then happily embrace our future life of rural simplicity, artistic endeavour and certain poverty with no later regrets. This would be my last stand and after that she would never expect me to work as a doctor again. It seemed like a reasonable compromise at the time.

A few weeks later as I sat down with my first tearful, suicidal and desperate patient and talked for an hour or so over coffee and cigarettes, I knew that I was finally working in a situation that I could fully engage with, that allowed me to use the intellectual, creative and emotional areas of my brain and ultimately offered me a chance to actually make a difference to another human being in a way that I thought was important.

What’s the most interesting thing about your speciality/job?

I have now met three people who fully believed themselves to be, and indeed introduced themselves as “Jesus”; one memorably as “Jesus Satan Christ”.  I have never lost my sheer wonder at the numerous guises under which severe mental illness can present. To watch a person, whom you formerly knew well, transform by mania into a raging, tormented being capable of staying awake for days on end with seemingly inexhaustible reserves of energy is an aspect of our shared human experience not witnessed by many in society these days. Mental illness has a genetic basis and occurs in all cultures, all countries and will have been present throughout all of our history. Having actually witnessed its many forms has led to a change in my view of our species and made me consider the world quite differently to how I did before. I think that those working in psychiatry generally get to meet a wider range of people than those in other fields, since we tend to be more likely to professionally encounter those at the fringes of the normal distributions of accepted beliefs and lifestyles. My respect has also grown exponentially for the creativity of the human brain from some of the ideas, delusions and neologisms that I have encountered. I recall one patient explaining his genuine fear of “splattercation”. This was a process where he believed that he was, within a very few hours, to transmute into a foetus and then, being conscious throughout, miscarry from a womb; during which process he would experience unimaginable pain. His genuine breathless and dry-mouthed terror at this prospect was almost palpable as he described it, and the room in which we spoke seemed to close in around us as he described the horror awaiting him. Indeed, his genuine conviction of belief was so great that, for a fleeting moment, I was tempted to absolutely believe him.

There can be an “other-worldly” quality and force in some patients with illnesses at times and I quite understand why even the most rational of our ancestors, lacking the experience of generations of professional observers, could have concluded that possession by demons or some form of witchcraft were entirely reasonable explanations to explain the phenomena that they witnessed in people under the influence of some illnesses. 

What has been your best moment in medicine?

This unexpectedly came about a year after I had finished my six month Obs and Gynae job as part of a GP training rotation. One of my last Outpatient appointments was with a lady undergoing fertility treatment. When her last round had failed, earlier in that placement, I had spent a long time consoling her and she had asked me, between sobs, about my family. I was honest with her and told her that my wife and I had also undergone investigations for this same problem, but once Nature had known the game was up, we had been blessed with two children quite naturally without the need for anymore nasty tests or poking about with unpleasant equipment.

On this day, as she was helpfully brought in before I had finished reading the notes, I came across a result form showing that her recent pregnancy test had been positive. I suddenly realised that she was there to find out her latest result, no doubt already resigned to adding yet another negative to the ream of misery in her notes. For the only time in my career I asked her to give me a moment, left the room and out of her earshot confirmed with the laboratory that there could be no possibility of an error. After witnessing her previous distress, I hardly dared to believe the almost miraculous result on the paper and, due to my inexperience and lack of confidence, had been seized by an anxiety not to be responsible for falsely raising her hopes. The lab staff were very kind to me and calmly listened to my garbled explanation before gently confirming the result and reassuring me that they had yet to find any grounds to suspect incompetence in their department when performing tests and publishing results. I returned to the consulting room and on walking through the door simply spoke the one word that she wanted to hear. "Pregnant". "What?" "You’re pregnant. I'm going to discharge you from the clinic. You’ll need to go and book into the antenatal clinic and we'll see you there". She stared at me and I watched her eyes slowly fill with tears. No further words passed between us before she quickly stood up and left the room in an undignified hurry to 'phone her husband. I closed the office door, dabbed my own eyes and carried on with the clinic.

About a year later I was out shopping with my wife and children in our local town when I noticed an oddly familiar lady speeding a push chair on a collision course towards our family group. I didn’t immediately recognise her, but knew that I had met her professionally in the past. She appeared a bit younger than I remembered her, but out of courtesy and in spite of me having totally forgotten her name and medical history, I cheerily greeted her as though I did remember and then proceeded to briefly introduce my wife and children all the while wracking my brain for more data. As ever, my wife took it unblinkingly in her stride, as this lady then loudly announced to the Town Square “You promised me that you’d get me pregnant Dr. Leahy, and look what you did".

And your worst?

The event that forever deprived me of the ability to be truly carefree happened during the six months that I worked alone at night in an A and E department unsupervised and entirely unsupported, having only left University twelve months before. One morning, at about seven o'clock, an ambulance pulled up outside the major trauma entrance; no siren and no lights. I was totally exhausted after a busy night, and so wearily trudged into resus, trying to motivate myself up to having a go at dealing with the next terrible situation. A crew member walked in carrying something, handed me a triage sheet and said that they had brought in a cot death. And so, a moment later, I was left alone in the resus room with a plain wicker basket in which lay the still body of a blue-lipped baby. The one, as I soon learned, whose parents, on that clear, bright summer morning, had assumed to have simply had a good night's sleep, and which beloved first child they had then joyfully got up together to awaken. I had a baby at home about the same age whose face I suddenly had to block out. Then, using all my emotional reserves to suppress any feelings and taking several deep, gasping breaths, I performed my duty of formally pronouncing death. I had to go and speak to the parents, write up a card and arrange for the Coroner’s Officer to be informed before trying to forget what had just happened and return to the endless cubicles and relentless battle against the waiting time. For the next two hours I made myself appear professional and deeply interested in such medical wonders as a sprained ankle, a grazed knee and a cut hand while I fought to contain the maelstrom of thoughts demanding my attention. I acted out my role until 9 o'clock when my lone vigil ended and I finally got outside to sunlight, fresh air and the reassuring sanctuary of my car. I got off the car park and about 100 yards down the main road before suddenly falling apart in a quite spectacular manner. I don’t remember the drive home, only my absolute conviction in knowing whose face I needed to see and whose small warm body I needed to cradle in my arms as my wife later hugged us both.

These years later and having watched my children grow up, I still sometimes find myself thinking about that couple and that morning. I have eventually evolved the art of retreating inwardly to safer areas of my mind when it comes on. There are a few experiences that come back to me every so often, but that one is the worst I think because of when it occurred in my life, as a new parent, and at a time before I had had a chance to grow my “professional armour”. When such thoughts arrive unbidden in my mind, usually triggered by an association with something quite innocent I see or hear, my family become aware that I have "left the building”. If pointed out to me, I "come back in" and might offer a quip about early dementia, but really I now don't believe that I will ever forget it. I’m thankfully spared the memory of exactly what was said in that stuffy and impersonal interview room where I met them. I remember fighting hard to hold my boundaries as a doctor and not speaking from the heart as one parent to another as I so longed to do. It was not the time or place for me to expose my feelings. They were suffering enough and did not deserve any more raw emotion to deal with. I can only hope that I managed to contain mine, appear professional and just give them the facts, but that memory is gone. What comes back are those few minutes of standing in the resus room alone with that tragic child, the creak of the wicker as I unbuttoned the baby-grow, the long minute of listening to a tiny silent chest and noticing how it was so dwarfed by my stethoscope, and then having to shine my pen-torch into two little, lifeless eyes.

What advice would you give prospective doctors?

My first advice is to watch the Shrek series of films. For non-doctors to understand my perspective, you should know about the recent past. I was an elder of the lost tribe of SHOs that you may have read about. To understand this reference you need to know that years ago when you qualified you were allowed to get a job here and there as you fancied, try a bit of this and that and only have to do an exam every so often when you felt up to it. Otherwise you remained a SHO (Senior House Officer) and could work at this level for years with no end in sight. I didn’t mind, but most people were keen to pursue a definite career and didn’t like the uncertainty of when they would move on. They had to wait for vacancies at the next level, it was very competitive and there were no rules to the game. You might spend ten years training to be a surgeon and then be taken aside to be told that you had wasted your time and that you should really consider going and training to do something else. For somebody like me however, I could flit about and have a go when it suited me. I liked the freedom, but nowadays you simply cannot work like this and have to sign on to a fixed length training scheme or it can be very difficult. The organisers in charge of the scheme tell you where to work and when you have to do the exams, usually within strict time limits. If like me you either do not or will not play the game, then you’re out.  And once out of a training scheme, the added curse is that you may never again return to train in that field. Hence, I am now banished and will never be allowed to become a Consultant, but fortunately I had done enough to be able to get into a long-term junior job before the way was blocked forever. And so I now watch the big game from the sidelines, follow the changes and reminisce about the old ways.

I warn any prospective doctors that they are undertaking a life-changing challenge when taking on a medical career. They should know that everybody finds it enormously difficult to complete the studying required. I can still remember the charged and silent atmosphere on our student corridor the night before any exams and an inspirational and quite brilliant fellow student of mine, now a Professor of Surgery, often commenting that he found some of the exams a “nightmare” and meaning it. I would however like to focus on the personality requirements for this career and then to explain why, by conventional measures, I have failed in it.

Shrek would have made an excellent doctor. If you have watched the films you will notice how he applies himself to the task in hand in and copes well with setbacks. All of the villains would equally be successful because, guided by a clear vision of what they want, they are willing to sacrifice their time and work hard to achieve their ends. I have always struggled in this profession because I wanted to stay as Donkey. I wanted to be happy all the time, free of any cares and aim for a happy marriage and children as my priority achievements in life. If like Donkey and me, when placed in front of some complicated and dull book, after reading a couple of lines your first thought is "Who fancies an ice-cream?” then, like me, you will struggle in this profession. It has nothing to do with intelligence, kindness, morality or a good heart. Donkey has all of these. It is to do with priorities.

Let us be quite clear about one thing. Characters like Rumpelstiltskin now control the land of medicine and will control your access to career progression by putting harsh tests in your path to make sure that you are as totally committed to excellence and success as people like them. Otherwise, they will just view you as a harmless donkey and let you flounder. They will feel no obligation to help you, since emotional intelligence and personal happiness will never be prioritised as desirable assets over the currency of achievements. As long as you're aware of these facts and, very importantly, can accept them, you can be happy. But be prepared for harsh criticism when failing tedious exams and people getting upset if you just view your time at work as a job and not as a chance to progress through suffering. In spite of priding themselves on their time-management skills, their 9-5 often runs from 7-6. You will also be expected to submit to this discipline and if you should dare to point out that you enjoy breakfast, like to take your children to school and look forward to your life after work, they will get genuinely angry. These are not the areas that they will wish you to prioritise.

My downfall in the medical world was that I refused to accept this, would not change and was resolute that my children would be brought up by parents like Dragon and Donkey. To this day, if I have to read anything medical which is at all dull or tedious, I still suddenly begin thinking about leaving it to go and look for: an ice cream; a cold beer; a movie to watch or music to listen to. As a result of my refusal to submit to the discipline, when I retire nobody will have heard of me, there will be nothing named after me and, most importantly, I will never teach you. I cannot overemphasise the importance of knowing that Professor Donkey will not be interviewing you either for medical school or at any point beyond.  So please now be aware of the sort of people who will, and what attributes they will be looking for in your personality.

What’s been your favourite doc2doc discussion of all time?

My favourite moment on doc2doc to date ever was when our colleague "somestudent" brought the existence of the Piraha tribe in the Amazon to my attention during our discussion on “Is religion fundamental to human nature?” These people are possessed of a truly unique outlook on life amongst humanity. It is a rare thing nowadays for me to get so excited by learning something totally new and so genuinely interesting.

What do you do when you are not being a doctor?

My selfish passion is rock guitar. My first gig was in 1977 and I have been in bands ever since. Once I realised that medicine was never going to delight me in the same way – during my A and E experience, just over a year after qualifying - I grew my hair halfway down my back, sprouted a large beard and then, on nearly every weekend that I wasn’t working for the next twelve years, played guitar in a cabaret band on the Northern Club circuit. A financially profitless venture supported by the day job, but as a musical training, rewarding beyond value. Two hours of ever-changing repertoire having to be memorised and performed with no paper in front of you, with the added requirement of having to be able to suddenly improvise over any song takes a bit of work, but through sheer repetition and the development of muscle memory, I finally began to have short runs of watching my own hands move as if by themselves, to produce out loud what I heard in my head a moment before.

As the children and I got older however, I found coming home at dawn on Sunday mornings after several hours on a dark motorway less appealing and realised that the time had come to shave the beard off and get a haircut. I still adore the intellectual and emotional immersion of performing live, but now only play in local pubs and for occasional biker events. I also perform with a trio locally for wedding receptions, christenings etc., play the mandolin in a folk band, provide music for our Church and even did the music for a couple of Church pantomimes, in the process having to learn to use software to write, arrange and perform music. I try and practice guitar for two hours every night when I first get in, before coming down to dinner and a few pints of home-brew; another rewarding hobby. I enjoy visiting pubs that serve real ale, but the village pub is still my favourite where my wife and I can go and discuss all sorts of subjects with the other regulars, usually with much hilarity, now that our children no longer want to spend as much time with us, and are themselves usually off doing things now that they can both drive.

I wish I could afford to spend more time and money on our joint marital study of French wine varieties and regional foods and that I could devote more hours to the piano in order to assist my desired progression to church organ, but ultimately I have had to conclude that I would need the other 40 hours a week in my life to achieve all that I would like to.