Private difficulties, public pain

When reality collides with fantasy

24th November 2023
Jo Cohen Jones

Private difficulties are brought into sharper relief when set against a backdrop of public pain, writes Jo Cohen Jones.

All of us, if we are really alive, are disturbed now in our emotions. We are faced by emotional problems that we do not know how to solve. We shall make no headway with these questions unless we begin to see them, and keep on seeing them, not as our private difficulties but as the growing pains of a new world of human experience.

The Scottish philosopher John MacMurray wrote these words in 1935, four years before the outbreak of World War Two and the Holocaust against the Jews. They came to mind recently, not because of the Hamas terrorist attack on Israel on October 7, but because a week before I had been diagnosed with lymphoma, and two days later my oldest daughter Sarah (not her real name) suffered a rare spinal injury damaging her lower body function. Our experiences were so unnerving that already traumatic events became layered by a deeper disturbance, brought into focus by the terrorist attacks, the British media response and the rise in antisemitism.

How are these events connected? I am a secular Jew training to be a psychodynamic psychotherapist. I don’t state these facts to validate my identity but to explain my perspective: I try to understand what drives people to do things that result in outcomes that are the opposite of what they claim to have intended. I add the descriptor ‘psychodynamic’ because there are many forms of psychotherapy. Psychodynamics comes from the work of Freud and the notion that an unconscious directs our attitudes and actions in ways we are not aware of, to avoid what he called ‘unpleasure’ and to protect ourselves from suffering. Over the last month, my daughter and I confronted this theory in its social manifestation: a wishful system of human relations and resources predicated on a chain of anxiety, aided and abetted by self-interested elites.

My journey began in July, with an online questionnaire to book an appointment with my GP. I was experiencing pain around my ear and I had a swollen gland. Once I’d understood that the helpful link ‘How to book an appointment’, actually meant, ‘Book an appointment here’, and navigated an online system called Patches, (apt in the context of everything falling apart), I faced kindly questions about what I was most worried about and how I would like the practice to help. After Googling headaches, I decided mine was probably an ear infection that could progress into the bone. I am a catastrophising Jew after all. How would I like the practice to help? Antibiotics. I then baffled a newly qualified GP, supervised by two seniors, with all the complex possibilities of my condition that dismissed the gland altogether, and came away with ear drops. That is the problem with kindly inclusivity. It gives power to people who don’t know anything, which confuses everything.

The earache returned and the gland turned out to be a tumour. I had tests and was allergic to something in the PET scan. I was sent to the Accident and Emergency department and, five hours later, I learned I had not had a heart attack but my heart rate was abnormally slow. I had suspected something was wrong a few months earlier, and saw the doctor with heart flutters. He sent me for a 24-hour holter to measure my heart rhythm but the results were not followed up. I’d let it go but this turned out to be a mistake: something wasn’t right.

“That is the problem with kindly inclusivity. It gives power to people who don’t know anything, which confuses everything.”

In the meantime, my daughter’s cats had started a flea infestation and, while clearing her house for the fumigators, she hurt her back. Sarah called me on Tuesday to say her leg felt numb. I told her to go to the doctor and the doctor told her to go to the hospital. An MRI scan revealed a slipped disc and compression of the cauda equina nerve bundle – which controls all feeling below the waist. In an unfortunate coincidence all three of the hospital’s spinal surgeons happened to be on holiday at the same time. Thankfully, one managed to review the images on his phone at the airport and consulted with a specialist neurology unit about whether to transfer her. The decision seemed to be to wait till he got back. As movement continued to deteriorate in Sarah’s foot however, what to do next became unclear. At the hospital, everyone was nice but no-one could give a definitive opinion or move things along.

I tried to distract myself with tasks. Collect the cats from my daughter’s house. Clean out the fridge. Somewhere along the line, I punctured my finger in a dustbin full of stagnant water. Now I needed a tetanus booster. My GP said this had to be done within 48 hours and could only be carried out at an Accident and Emergency department because guidelines dictated I also needed immunoglobulin which they didn’t have. More worried about my daughter, I went back to the hospital. But the decision to move her could still not be made.

Wednesday was full of confusion. Sarah’s mobility continued to deteriorate. I tried to reason with the duty doctor. Surely it made no sense to wait to transfer her until her condition ticked a box called, ‘Emergency’, by which time the damage to her spine could be irreversible. He agreed but was not the decision-maker. My daughter was also hungry, not having eaten for 24 hours in case she had to undergo surgery. Now we were told nothing would happen imminently and she should eat. But Sarah is coeliac and lactose intolerant. Gluten and dairy make her ill. The hospital catering team was bewildered and provided a cheese sandwich, a combination of wheat and milk which most people would recognise as unfriendly. Their solution was to consult the dietician who didn’t understand what coeliac was, produced a booklet containing the ingredients of every dish available, and told Sarah to work it out. I arrived with provisions but outside of visiting hours. A nurse called for Security who searched the bathroom in case I was hiding and insisted on being alerted should I return. Amid all of this, a Nigerian nurse demanded to know where my daughter was really from, as apparently the colour of her skin meant she couldn’t be British.

Everything about this is wrong. Why were three spinal surgeons on holiday at the same time? How is it possible to review something as serious as a possible cauda equina injury on a phone? How could the catering department of a major London hospital not know what coeliac disease is, let alone the dietician? Why weren’t the results of my heart rhythm holter followed up? How could a GP be blindsided by a patient’s anxieties and not attend to diagnostics? How could a nurse worry more about the appearance of a concerned mother than a patient’s diet, or press her about her ethnicity when she wasn’t well? As John MacMurray says, these are not private difficulties but the pains of a new world of experience. Our focus is trained in the wrong direction.

“As a society, we appear to be falling apart. We prefer fantasies over reality, simplicity over complexity and we try to ignore disturbance.”

By Thursday, I was running out of time for my tetanus booster. But the decision had finally been made to transfer my daughter to a specialist facility. A bed was available but Sarah had to be transported. She was listed as a Category 2 patient which designates an ambulance response time of 40 minutes. This applies to serious conditions, equivalent to a stroke. As the hours passed, no-one worried about visiting times anymore. I decided to go to Accident and Emergency for my tetanus booster and told the nurse, in case the ambulance arrived while I was gone. She failed to tell me that the hospital was now closed and so it was only when the door shut that I realised I wouldn’t be able to get back in.

A&E was a horror show, a warzone of a different character to the nightmare about to unfold in Gaza. The man in front of me, high on something, was just looking for a place to stay. The staff were heroic. I didn’t want to add to the chaos and so went home and slept for three hours. At 4.30am, I went to my local hospital where I waited an hour and a half for the tetanus jab. The friendly receptionist told me she’d worked in A&E for 23 years. Her solution to the chaos? ‘If anyone ever asked me, I’d tell them they have to charge every patient £10,’ she declared. ‘How about a 5p honesty box?’ I suggested. But she was adamant. £10.

My daughter’s ambulance took seven and a half hours to arrive. Sarah arrived at the specialist hospital on Friday morning and was operated on at 2pm, the day before Hamas attacked Israel. A doctor explained that the surgery had been a success, although her disc had come out in fragments, and they hoped all would be well. It turns out, these doctors thought the original hospital would perform the operation, but communications had broken down. I saw what was happening in the outside world but couldn’t attend to it. Instead, I was meeting my haematologist and apologising for the red lesions over my torso. Fleabites, I explained. My daughter, meanwhile, was making friends with the people on her ward. A woman who had been waiting for years for surgery for her Parkinson’s had received a cancellation slot. A woman with water on the brain and a shunt into her stomach cheerily told Sarah about her many children and how her condition meant she couldn’t work. A woman recovering from surgery on her skull didn’t look well at all.

“Alarmingly, a consensus seemed to be growing that, when it comes to Israel, the terrorists are the victims and the real bad guys are those who dare to stick up for themselves.”

Back home, I washed clothes and ironed, followed events in the Middle East, and watched a show where the good guys killed the bad guys and made friends with honourable people. This was the fantasy we seemed to be trying to make real, evil overcome – only without anyone actually dying – and everyone bound in universal love. In reality, however, we are not all the good guys. Alarmingly, a consensus seemed to be growing that, when it comes to Israel, the terrorists are the victims and the real bad guys are those who dare to stick up for themselves.

Cut to the following Tuesday, with laundry abandoned I was reduced to a t-shirt at the bottom of the drawer. Its slogan read: ‘The Portable Jewish Mother. Guilt, food… and when are you going to give me grandchildren?’. Forgetting I was wearing it, I took the cats to the vet. The vet was outside, smoking a cigarette and looking at his phone. He looked up. ‘Are you Jewish?’ he asked. It felt like a punch in the chest. My heart racing, I said, ‘Yes,’ and he showed me his phone. ‘I’m Israeli,’ he replied. My relief told me everything there is to know about fantasy and reality. Anti-Semitism is on the march once more.

My daughter came home that evening but, three days later, her leg was still not right. She called the hospital ward for advice only to discover she had mistakenly been given a clinical nurse specialist’s home phone number. Unsurprisingly cross at being disturbed, the nurse told us to wait and see, or visit A&E. Agonising followed. Was Sarah imagining things? How bad was the pain? We decided to take it seriously and went to the hospital. Six hours later Sarah had another MRI scan. The condition had recurred. Scans went backwards and forwards and conversations about beds and how to get back to the neuro hospital resumed. Nurses rushed here and there to check on a patient, say a kind word, organise Sarah’s transfer. Without exception they were black and brown, with varying levels of English.

Why were there no white British nursing staff? Is it because of the salaries and conditions? We know how difficult it is to make ends meet on a nurse’s wage and we have seen the pressures the staff are under. Perhaps it is only recent migrants who are prepared to accept this as a price worth paying for the freedoms and opportunities this country has to offer. Our political elite might be quick to label Britain racist, but these nurses saw something positive in the UK. They appreciate the freedoms that many in the west take for granted. Worse, as the anti-Israel marchers show, there are sections of our society who sympathise with Hamas, the terrorist leadership that denies the residents of Gaza these same individual liberties. To those demonstrating on the streets of London, it is Gazans alone who are deserving of sympathy. Indeed they are, but they are victims, first and foremost, of Hamas. Israel is forced to resist the delusion that it can preserve itself while also protecting Gazans from suffering. Because, in truth, the actions of Hamas are not just uncivilised, they are the barbaric acts of a death cult that wants to obliterate both Israel and Jews.

“Our political elite might be quick to label Britain racist, but these nurses saw something positive in the UK.”

A Chinese nurse took my hands and said, ‘Mummy, we are doing everything we can.’ They were. After midnight the doctors agreed that in the absence of available transport, my daughter could be transferred to the specialist hospital upright, by taxi. A&E were to book the cab. There was my tetanus receptionist friend, once more. ‘How are the cats?’ she asked, and brought blankets, as we waited on a deserted street at 2.30am, my daughter in a wheelchair that I had managed to manoeuvre down the ramp but hadn’t been able to get back up because there was no-one to help me.

On arrival, we met a duty surgeon, a brusque young woman with an Eastern European accent, who told my daughter at 3am that many people never recover from her injury. Two more young women from somewhere in Europe operated for the second time a few hours later, and now Sarah could move her foot. They were true magicians, operating in a world of pain and suffering, because this is how things really are, whether we like it or not.

This story doesn’t end because in the real world, it never does. My washing machine broke, I paid an emergency plumber £140 for a repair but still had to buy a new one. My daughter’s fumigators turned out to be cowboys and we had to start all over again, for another £240. A private physiotherapist, specialising in Sarah’s connective tissue disorder (which likely caused the injury) told her to do all the things her surgeon had told her not to do, dismissed the disorder as a label, and charged her £190. I’m still waiting to know the stage of my cancer and therefore what the treatment should be. Meanwhile, we watch the BBC fill our screens with Gaza’s displaced and dying rather than dissect complexities, we watch pro-Palestinian protesters suggesting that Israel is genocidal rather than a country trying to ensure its survival against terrorists.

In psychoanalytic terms, we might conclude that our individual is in the grip of a psychotic breakdown, his consciousness fragmented into splits between us and them, seeing enemies round every corner. The lucky patient is in a hospital that functions, the unlucky in prison. In pieces, the psyche has lost the link between cause and effect and feelings are mistaken for facts. As a society, we appear to be falling apart. We prefer fantasies over reality, simplicity over complexity and we try to ignore the disturbance marked out by John MacMurray. But the danger is this leaves us at risk of repeating patterns of behaviour that take us back to the places we vowed never to go to again. I refused to visit Auschwitz for this very reason. The real enemy lies within.

Jo Cohen Jones has volunteered in the youth offending system for the last ten years. She is currently studying Psychodynamic Psychotherapy.

Photo by camilo jimenez on Unsplash.