I am Rebecca

Why the pharmacist didn’t believe me, and what is says about how we view mental health.

Photo by freestocks on Unsplash

‘ I am Rebecca’.

The pharmacist didn’t acknowledge me. He continued with his warning.

‘You need to tell Rebecca that two of these drugs should not be taken at the same time.’

He shook his head.

‘I’m wary about giving you this prescription because she really needs to be having blood tests,’ he continued.

I had already had blood tests; this was not news to me.

‘It’s for me’, I replied, ‘I am Rebecca’.

He continued unabashed.

‘These drugs combined can cause cardiac arrythmia. I will give them to you, but you need to tell Rebecca to have regular blood tests and close monitoring by her GP.’

I thought I was going mad.

‘Yes’, I have had the blood tests, that prescription is for me.’

Undeterred he continued:

‘I am giving you these drugs on the understanding that you tell Rebecca what I have told you’.

I gave up.

‘Yes, I will’, I replied, now buying into this fantasy.

I walked away from the pharmacy counter. Confused and embarrassed. This was not the first time I had collected medication for my mental health. It was the first time though that I had collected it in the third person!

There was a certain inevitability about my diagnosis of postnatal illness. Mental health episodes were standard form for me, but the severity of this one was unexpected. At 6 weeks postpartum, I limped off to a rather wonderful GP (they do exist) and a rather amazing psychiatrist who started me on the road to recovery.

It was quite a pharmacological road with continuous titrations and dosage adjustments along the way, complete with all the unwanted and troubling side effects of my prescription cocktail. It was worth it and frankly I didn’t have a choice.

When my beloved baby was about 8 months old, I went to collect my prescription from my local pharmacy. I bumped into my good friend Susan along the way, and we approached the pharmacy counter laughing and cooing over the gorgeous little cherub giggling in the pram.

My prescription was for 3 psychopharmacological drugs, one of which I was being weaned off due to unwanted side effects (two stone weight gain — no thank you). The other was being introduced in as a replacement. Ordinarily a doctor would not prescribe the two simultaneously but in the Russian roulette of risk/benefit analysis it was decided I could take both together.

The pharmacist prepared the prescription and approached me with a concerned look. He was a small, kind looking guy, early thirties maybe but clinically experienced as he spotted the contraindication straight away.

Only it was obvious he did not believe the prescription was for me despite my protestations. It wasn’t noisy in the pharmacy; I was talking at a normal volume; he could hear me, and I was obviously comfortable talking about the prescription in front of my friend. Something in his mind stopped the connection.

He could not compute that the happy, chatty, latte swigging mother pushing her expensive pram with her fabulous friend, doting on the angelic child with the ruby red chubby cheeks and a smile that could melt ice, was the same woman whose need for psychotropic medication was so great a doctor was willing to risk cardiac complications?

I was in fact both of those women, co-existing, fluidly moving from one state to the other. He had caught me on a good day at a good moment (it could change hour to hour, even minute to minute initially). Bad days did not look like that day, but they were every bit as real.

Yet I understood his error in judgement, his incorrect assumptions, his reliance on medical text to form a version of an expected patient. I had already made that mistake myself in my own professional life.

Years earlier, during my training as a midwife, I worked with an inspirational midwife called Beth. Beth was in her late 60s and had delivered enough babies to fill a football stadium, but she loved and remembered every one of them. She was small, all plump around the edges with soft white hair. She appeared to float around the delivery rooms, and I often thought of her as the Fairy Godmother of the Delivery Suite.

Late one afternoon she gave me a quick handover that a woman, Gina, was coming into labour ward, close to delivery. Gina would either be alone or with her mum. It was Gina’s first baby, and she needed a ‘support squad’. Gina was on a methadone programme. I was sent to wait in reception for Gina. I was new to this midwifery game, but I thought I would be able to spot my new patient a mile off. I was wrong.

As I stood behind the delivery suite reception desk, I spotted a smart, confident, knocking on 40, obviously labouring woman accompanied by an equally smart, stylish and demure ‘grandmother to be’. Not the Gina I had envisaged in my mind. The young, bedraggled, cobbled together, swearing like a trouper, terrified and dazed, drug addled look (that I am ashamed to say I was expecting) was not for Gina.

Yes, Gina was on a methadone programme and had been for years following a dabbling with drugs in the 90s that got out of hand. She was also a successful teacher, in a loving relationship (her husband was working overseas and desperately trying to get back), an amazing daughter to her devoted mother and was an overall joy and honour to meet.

Beth, Gina, her mother and I waltzed around the delivery room, chatting, breathing and being, honouring the silence, howling with laughter at the cursing, holding Gina and bearing witness to an amazingly calm and serene birth. It was a moving experience for all of us — and the net result — a beautiful baby girl was testament to sum of the many parts of Gina. Both mother and baby ‘doing fine’ as the saying goes.

It is an understandable part of evolution that we seek to categorise immediately others that we experience — you kind of need to judge quickly if a presenting animal is a potential threat or a potential meal when you are prehistoric (wo)man, out on the open plains starving but in fear for your life.

But there are inherent dangers in quickly stereotyping and categorizing based on scant information. Arguably as medical professionals we are some of the worst culprits of judging a book by its cover (or by its medical notes or prescriptions) but the issue is universal.

Maybe the pharmacist was away with the fairies that day, maybe there was no prejudgment, and he was distracted by the complexity of the prescription but something in my gut tells me otherwise.

I once attended at group therapy session (of which I was a patient) in my work attire (I was working as a secretary at the time — think suit, heeled shoes, Zara blouse). The receptionist directed me straight into the consulting room and informed me that he would let my patients in as they arrived. We were both mortified when I explained who actually I was.

I am Rebecca. You are you. We are all composed of so many parts and possibilities. So many conflicting forms of existence struggling for integration and acceptance and so why does any of this matter?

Well, when we limit our expectations of people based on the presence of some factors (mental health issues, addiction issues, gender, ethnicity the list goes on) we limit societies expectations of those people and, crucially, their expectations of themselves — I believe the buzz word now is unconscious bias, but this has been going on since day dot — no buzzword required.

Similarly, when we base our expectations of people on the presence of other factors (gender, class, education etc.), we afford them unearned privilege and power (ex Etonian?… sounds like you belong in Government!).

Research shows we only need one positive contact with a stereotypical ‘out’ group member to change our perception of the whole group. Meaningful contact is important along with self-reflection and visibility if we are to improve the lives and opportunities of everyone and achieve equality for all.

And that is why I write and why I have chosen this as my first post. Person. Professional. Patient. Visible at last. I am Rebecca. Thanks for reading.